Evaluation of Cardiovascular Changes in Children with BAVs.

The objectives of this study were to investigate left ventricular (LV) function, aortic dilation, and atherosclerosis in children with mildly deteriorated isolated bicuspid aortic valve (BAV) function using echocardiographic studies and biochemical markers of atherosclerosis and to correlate results with normal children. Biochemical analyses indicating cardiovascular risk of atherosclerosis and vascular changes in the aorta in relation to BAV were performed in 41 children aged 5-15 years old with isolated BAV and in 25 children with tricuspid aortic valves. Evaluations of aortic valve structures and functions; examinations of the LV M-mode and ascending aorta Doppler; and measurements of the LV Tei index (MPI), propagation velocity, ascending aorta at four levels, and carotid intima-media thickness (CIMT) were performed. There were no statistically significant differences in CIMTs, plasma matrix metalloproteinase-9, tissue metalloproteinase inhibitor-1 levels, or other biochemical parameters indicating cardiovascular risk or atherosclerosis between study and control groups. Deterioration of LV function, which could not be seen with M-mode echocardiography, was evident by MPI. MPI values in the study versus control groups were 0.46 ± 0.080 versus 0.40 ± 0.086 (p < 0.05). Diameters of the aorta in the study and control groups were 19.7 ± 4.7 and 17.2 ± 2.8 mm (p < 0.05) at the sinotubular junction level and 20.6 (14.4-40.5) and 18.3 (12.4-24) mm at the ascending aorta level (p < 0.05). Increased aortic valve insufficiency was related to increased aortic diameter. No sign of atherosclerosis was detected in children with BAV. Deterioration of LV function was seen using MPI, and aortic dilation was related to the severity of aortic valve insufficiency.

Detection and characterization of the mandibular accessory buccal foramen using CT.

OBJECTIVE: To investigate the frequency and characteristics of the mandibular accessory buccal foramen (ABF) with CT. METHODS: A retrospective study was carried out using the CT records of 504 patients referred to the Erciyes University Medical School (Kayseri, Turkey) between 2007 and 2010. Presence, location, diameter, area and number of ABFs and their continuity with mandibular canal and distance to the mental foramen were evaluated using axial, sagittal and three-dimensional CT images. Statistical analysis was performed using SPSS® v. 15 (SPSS Inc., Chicago, IL), and t-tests were used for statistical analysis. RESULTS: 14 ABFs were observed in 10 (2%) of 504 patients. The frequency of ABFs was found to be 2.6% in males and 1% in females. The mean distance between the ABF and the mental foramen was 5.0 mm [standard deviation (SD) ± 2.48]. The mean long axis of the ABFs was 1.4 mm (SD ± 0.4) and the mean area of them was 1.5 mm(2) (SD ± 0.8). The mean area of the mental foramen on the side with the ABF was 4.1 mm(2) (SD ± 2.71). CONCLUSIONS: This study presents a relatively lower frequency of ABFs than that in the literature. These foramina could have more complex neurovascular structures than was previously thought. Thus, in special cases where a direct surgical exploration during the planned surgery is not indicated, CT or cone beam CT examination to determine the possible presence of ABFs may be indicated.

Oral mucosal involvement in Langerhans' cell histiocytosis: long-term follow-up of a rare case.

Langerhans' cell histiocytosis (LCH) is a rare disease where different organs and systems may be affected. Oral involvement generally consists of mucosal ulceration associated with lesions of the underlying bone. Many reports exist about the misdiagnosis of this disease. Various symptoms may lead the clinician to an incorrect diagnosis, especially with multiple organ involvement. Oral manifestations are common, and dentists should be aware of this disease and evaluate intraoral findings accordingly. This study presents an LCH case characterized by oral mucosal ulcerations with no involvement of the underlying bone. A definitive diagnosis was made by open biopsy from the oral mucosa.

Incidental finding of a proatlantal intersegmental artery. A case report.

We describe the case of a 70-year-old woman who had a left proatlantal intersegmental artery disclosed during carotid artery angiography with the findings of carotid-basilar anastomosis which originated from the petrous segment of the ICA and was filling the horizontal segment of the vertebral artery. Awareness of this vascular variation can prevent morbidity and mortality associated with carotid ligation or carotid endarterectomy, especially when an incomplete circle of Willis is present.

Anterior Stafne bone defect mimicking a residual cyst: a case report.

Stafne bone defects (SBDs) are asymptomatic lingual bone depressions of the lower jaw that are frequently caused by soft tissue inclusion. The common variant of SBDs exists at the third molar region of the mandible below the inferior dental canal and has been mostly diagnosed incidentally during routine radiographic examination. The anterior variant of a SBD (ASBD) is relatively uncommon and is located in the premolar region of the mandible. Sublingual salivary glands are thought to be responsible for ASBDs. However, other structures such as lymphoid or vascular tissues might be associated with ASBDs. In the present report, an ASBD which was mimicking a residual cyst was diagnosed with the aid of a three-dimensional CT scan. ASBDs might be confused with other odontogenic or non-odontogenic pathologies because of their location and lower occurrence rate. Advanced imaging modalities, especially CT scans, are useful to assess such lesions in order to avoid unnecessary surgery.

Endovascular Treatment of Isolated PICA Insufficiency. A Case Report.

The vertebral artery terminating in the posterior inferior cerebellar artery is rare but it may cause cerebellar infarction when total occlusion of the vertebral artery occurs. Therefore treatment of vertebral artery stenosis in these patients is crucial. Surgical treatment of osteal vertebral artery stenosis is possible but is associated with approximately 4% mortality and up to 20% risk of procedural complications including perioperative VA occlusion, Horner syndrome, lymphatic injury and injury to the phrenic, vagus, laryngeal and thoracic nerves. Therefore percutaneous angioplasty with or without stent placement is emerging as an alternative treatment method with a high success rate and good initial angiographic outcome. Percutaneous angioplasty of the VA origin is associated with an approximately 15% restenosis rate. Stent placement is believed to decrease the incidence of elastic recoil and restenosis. Herein we present a rare symptomatic case with an anomalous, small-caliber right VA terminating in the PICA which was successfully treated with a drug-eluting stent.

The role of diffusion-weighted magnetic resonance imaging in intracranial cystic lesions.

We aimed to define the diffusion-weighted magnetic resonance (MR) imaging features of intracranial cystic lesions and to investigate possible special features for the differential diagnosis. One hundred and twenty patients with intracranial cystic lesions were included in the study. There were 29 arachnoid cysts, eight epidermoid cysts, 34 primary tumors, 18 abscesses, 29 metastases and two hydatid cysts. Echo-planar diffusion-weighted MR imaging was obtained in addition to conventional cranial MR scans. The morphologic features of the cystic portion and the wall of the cyst and signal intensities on diffusion-weighted images were evaluated. All abscesses and epidermoid cysts were hyperintense on diffusion-weighted images. Arachnoid cysts, hydatid cysts, primary tumors, and metastases were hypointense except five cystic tumors. These five primary or metastatic necrotic tumors showed high signal intensity on diffusion-weighted images due to hemorrhage or superinfection. The walls of the cystic tumors were usually hyperintense on diffusion-weighted images in contrast to the wall of the abscesses, which were iso-hypointense. This was a statistically significant finding for the differentiation between tumors and abscesses (p<0.05). Diffusion-weighted MR imaging is a useful technique for the evaluation of the intracranial cystic lesions and provides additional beneficial information to conventional MR imaging. However, the presence of hemorrhage and superinfection of the tumors may cause a signal increase that results in misinterpretetations. In these cases, the appearance of tumor wall may be useful for differentiating abscesses from tumors.

Embolization of postbiopsy and postnephrostomy complications in transplanted kidney: a case report.

Complications such as arteriovenous, arteriocalyceal fistula, pseudoaneurysm, or perinephric hematoma occur in allografted and native kidneys after interventional procedures. When these complications are not detected and treated immediately, they might be associated with a poor allograft prognosis. Reoperation may produce parenchymal injuries, therefore, endovascular embolization may be a preferred treatment modality. Herein we report an arteriocalyceal fistula and an arteriovenous fistula in a transplant kidney that were detected after biopsy and nephrostomy, respectively, they were treated with endovascular coil embolization. Percutaneous treatment is a safe and effective method for arteriocalyceal fistula and arteriovenous fistula following interventional procedures in renal allografts.

An unusual cause of dyspnea: myelomatous involvement of cricoid cartilage. A case report.

Extraosseous multiple myeloma involving the cricoid cartilage is exceedingly rare. CT is invaluable for detecting this lesion. Herein, we describe a patient with worsening dyspnea due to involvement of the cricoid cartilage with multiple myeloma. CT not only detected the lesion but also revealed additional classical lytic lesions of multiple myeloma. In patients with worsening dyspnea laryngeal involvement should be included in the differential diagnosis.

Granulomatous mastitis: radiological findings.

PURPOSE: To evaluate the radiological, ultrasonographic, and magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis. MATERIAL AND METHODS: Between April 2002 and June 2005, the mammography, ultrasound, color Doppler ultrasound, nonenhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated. RESULTS: On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen. On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen. Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect. Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen. The time-intensity curves differed from patient to patient and from lesion to lesion. CONCLUSION: The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions.

Small cell carcinoma of the lung presenting with ocular metastasis. A case report.

Metastasis to the eye is rare but it may be the presenting symptom. Therefore awareness of the radiological findings of metastasis may aid in establishing its diagnosis. Here we report an ocular metastasis of small cell carcinoma of the lung presenting with pulmonary and ocular manifestations.

Atypical imaging findings of infantile hemangioendothelioma: a case report.

Infantile hemangioendothelioma is the third most common hepatic tumor in children, and the most common benign vascular tumor of the liver in infancy. On computed tomography (CT) and magnetic resonance imaging (MRI), typical enhancement patterns similar to those seen in adult hemangiomas may help establish the diagnosis. However, atypical enhancement patterns may also occur. In this paper, we report a rare form of solitary infantile hemangioendothelioma that showed a rim-like calcification and rim-like enhancement on CT and MRI.

Tongue abscesses: MR imaging findings.

BACKGROUND AND PURPOSE: A lingual abscess is difficult to diagnose in the absence of physical signs. MR imaging may provide an excellent and invaluable adjunct to clinical examination, but the literature is incomplete in defining the various MR imaging findings of abscess. The objective of this study was to determine the MR imaging features of tongue abscesses. METHODS: Seven surgically proved tongue abscesses were evaluated with MR imaging. Four patients underwent MR imaging because of suspected tumor, and 3 patients, to show the extent and precise anatomic location of the lesion. Lesions were assessed with regard to the location, size, signal-intensity characteristics, and pattern of contrast enhancement. RESULTS: Five lesions were located in the anterior tongue and 2, in the posterior tongue. The central parts of 4 anterior tongue abscesses were hypointense, surrounded by a hyperintense wall on T1-weighted precontrast images. On postcontrast images, marked wall enhancement was detected. On T2-weighted images, a markedly hyperintense central part surrounded by a hypointense rim was seen. In 2 of these patients, there was a hypointense halo surrounding the wall (target sign). In 3 patients, a perilesional hyperintense area that enhanced diffusely after contrast administration was detected on T2-weighted images. The smallest lesion located in the anterior tongue was hypointense on T1-weighted images and enhanced diffusely on postcontrast images. On T2-weighted images, a markedly hyperintense central part surrounded by a mildly hyperintense peripheral part was depicted. Posterior tongue lesions appeared as polypoid ill-defined masses and were hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images. On postcontrast images, the lesion in 1 patient showed diffuse and heterogeneous contrast enhancement, whereas the lesion in another patient enhanced peripherally. The lesions were totally excised in 4 patients and drained with surgical incisions in 3 patients. No recurrence was detected on follow-up. CONCLUSION: An abscess typically presents as a cystic lesion surrounded by an enhancing capsule formation, but lesions may also present as solid masses that enhance diffusely or peripherally.

Ultrasound guidance in intracranial tumor resection: correlation with postoperative magnetic resonance findings.

PURPOSE: To determine the inter-method agreement between intraoperative ultrasonography and postoperative contrast-enhanced magnetic resonance imaging (MRI) in detecting tumor residue. MATERIAL AND METHODS: After resection was completed, the cavity borders of 32 tumors were examined with a 7 MHz intraoperative probe. Any echogenic region >5 mm in thickness extending from the surgical cavity into the brain substance was taken as the sonographic criterion for residual tumor. A continuous echogenic rim< 5 mm was considered normal. Results were correlated with gadolinium-enhanced MRI obtained within 48 h after surgery. RESULTS: The kappa value for inter-method agreement was 0.72. There were four cases in whom MRI showed residue despite a negative sonography: extensive edema or Surgicel along the cavity borders (three cases with glioblastoma multiforme) and the cystic component in the vicinity of cerebrospinal fluid (a case with pituitary macroadenoma) may be the reason for the residue going undetected. In a case with glioblastoma multiforme, residual enhancement was < 5 mm in thickness. CONCLUSION: Intraoperative ultrasound is an effective tool for maximizing the extent of intracranial tumor resection. Surgical use has to be minimized if intraoperative ultrasound is to be used as an adjunct to surgery. Tumors with preoperatively detected cystic components in the proximity of CSF-containing spaces have to be carefully evaluated with intraoperative ultrasound if residual cystic components are to be detected. A low-thickness echogenic rim should not be considered a reliable sign of the absence of residue.

Magnetic resonance imaging findings in chronic carbon monoxide intoxication.

PURPOSE: To define the cranial magnetic resonance imaging (MRI) features of the chronic stage of carbon monoxide (CO) poisoning in patients with and without neuropsychiatric sequelae. MATERIAL AND METHODS: Eight patients who had neither symptoms nor neurological sequelae and eight patients with neuropsychiatric sequelae were included in the study. Patients aged between 9 to 57 (mean 32.2 years). All patients had been comatose at initial admittance and awoke after normobaric 100% oxygen therapy within 1-7 days. In this study, the patients were being examined with routine cranial MRI between 1 and 10 years (mean 3.4 years) after exposure to CO. RESULTS: The most common finding was bilateral symmetric hyperintensity of the white matter, which was more significant in the centrum semiovale, with relative sparing of the temporal lobes and anterior parts of the frontal lobes on T2-weighted and FLAIR images in all patients. Cerebral cortical atrophy was seen in 10 patients; mild atrophy of cerebellar hemispheres in 8; and vermian atrophy in 11. Corpus callosum was atrophic in one patient. Bilateral globus pallidus lesions were seen in three patients. The lesions were hypointense on T1-weighted images and hyperintense on T2-weighted and FLAIR images. CONCLUSION: Patients with severe CO intoxication may develop persistent cerebral changes independently of their neuropsychiatric findings in the chronic stage. They may present with characteristic MRI findings as described here, even if asymptomatic. The history of CO exposure is therefore helpful for recognizing and interpreting the MRI findings of chronic stage CO intoxication.

Epidermoid cyst of the testicle: unusual magnetic resonance imaging findings.

Epidermoid cyst of the testis is an uncommon benign tumor that can be treated by organ-preserving surgery when diagnosed preoperatively. Although some sonographic characteristics may be suggestive of epidermoid cysts, sonography is not completely diagnostic. Magnetic resonance imaging (MRI) findings may provide support for the diagnosis of epidermoid cysts. The MRI findings of testicular epidermoid cysts have been reported as either bull's eye or target in appearance, or with signal intensity characteristics more typical of a cystic lesion. In this paper, we present typical sonographic and unusual MRI findings of a testicular epidermoid cyst.

Two new intramedullary implant designs for phalanx fixation in digital replantation: an experimental study.

Bone fixation in digital replantation must provide adequate rigidity, and must be applied in a fast and easy manner. Various fixation methods have been used so far with certain advantages and disadvantages. The authors report two new intramedullary proximal phalangeal implant designs to secure two amputated bone segments tightly. They compare their intramedullary implants with commonly applied K-wire fixation methods and plate fixation via biomechanical analysis in terms of bending rigidity and distraction strength. Their two-sided asymmetrical screw provided the highest rigidity and distraction strength, whereas the hook-trap system was nearly equal to cross-K-wire fixation. Intramedullary bone fixation may be a feasible method of bone fixation, and resorbable implant materials and different implant configurations deserve further investigation.

Comparison of immune response to nerve allograft segments in fetal and adult rabbits: a histological study.

Fetuses, as opposed to adults, are immature immunologically and it has been proved that they can tolerate allograft materials much better than adults. In this study the rejection phenomenon of nerve allografts was compared histologically in fetuses and adults. The study was performed in 60 New Zealand rabbits (30 pregnant and 30 nonpregnant), and allograft nerve segments were obtained from Chinchilla rabbits. The animals were divided into fetal and adult groups. Each group was studied at various time periods. Nerve allografts were placed under the panniculus carnosus in the interscapular region of the fetuses and adults. In both fetal and adult groups, the nerve allograft segments were assessed histologically after 1, 7, and 30 days. The criteria used during the evaluation were the degenerative findings in the myelinated axons (large, medium, and small axons), changes in Schwann's cells, and the quantity of infiltrating cells. The changes were graded microscopically from 0 (no change) to 3 (severe destruction and cellular infiltration). Cellular infiltration was more extensive in the adult groups than in the fetal groups. Earlier fetal groups showed minimal infiltration, but the response became more extensive in the later fetal groups. This is probably related to the removal of the fetuses from their intrauterine environment. When comparing fetal and adult groups, the results were significant (p < 0.05). The fetuses tolerated the nerve allograft segments better than the adults. This may be related to the immature immune system of the fetuses.

Intrasphenoidal migration of a premaxillary Kirschner wire.

OBJECTIVE: The use of Kirschner wire for the fixation of premaxilla is a well-known method in bilateral cleft lip surgery. We report a case in which the Kirschner wire of the premaxillary fixation had migrated intrasphenoidally. RESULTS AND CONCLUSIONS: The foreign body was accidentally discovered during a cephalometric analysis and was taken out surgically through an upper lip sulcus incision. Although the wire remained asymptomatic for 10 years, it constituted a potential danger for intracranial migration.