New radiological clues in the diagnosis of spindle cell oncocytoma of the adenohypophysis.

AIM: To present three new cases of spindle cell oncocytoma (SCO) from a single centre and to identify new radiological clues in the diagnosis of SCO according to the information obtained from the cases presented. MATERIALS AND METHODS: Three adults with SCO confirmed at histopathology were retrospectively reviewed. The medical records, imaging findings, operative notes, and histopathology findings for each patient were recorded. Magnetic resonance imaging (MRI) findings were evaluated, including tumour localisation, tumour size, signal intensity, imaging features on T1-weighted and T2-weighted images, and contrast enhancement characteristics. The study protocol was approved by the institutional review board. Informed consent was obtained from each patient. RESULTS: T1-weighted imaging (WI) and T2WI demonstrated millimetric hypointense foci and linear signal void areas in all lesions. Consistent with the hypervascular features of the tumour, intense contrast enhancement was observed during the early stages of dynamic contrast enhanced (DCE) MRI. Linear signal void areas showed contrast enhancement, but some of the hypointense millimetric foci remained without contrast enhancement. CONCLUSIONS: Although the radiological findings and preoperative diagnosis of SCO have been reported to be non-specific and impossible, respectively, in the literature, the characteristics of MRI and different patterns of contrast enhancement can help in recognising this rare entity. This article represents a single institution case series of SCOs and also includes the first description of a correlation of the histopathological findings with radiological findings and new clues in the differential diagnosis of SCOs. We described these new radiological clues as "Hasiloglu's Signs".

Atherosclerotic risk factors and premature atherosclerosis in acromegaly before and after 48 months of octreotide-LAR treatment.

We studied premature atherosclerosis with carotid Doppler ultrasonography in active acromegaly before and after treatment. Patients (n = 27) with active acromegaly and 12 age-, gender-, and body mass index-matched healthy individuals were included in the study. Carotid intima-media thickness was decreased significantly in the inactive group after treatment (median: 0.6 mm, interquartile range [IQR]: 0.55-0.80]) when compared with the active group (median: 0.9 mm [IQR: 0.75-1.15], P < .0001), but there was no significant difference between the inactive and control groups. There was a correlation between homeostasis model of assessment-insulin resistance (P = .01, r = .41) and growth hormone (GH; P < .0001, r = .46). In conclusion, premature atherosclerosis was demonstrated in active acromegaly patients probably as a consequence of insulin resistance and direct vascular effects of GH and/or insulin-like growth factor 1.

Detection of bladder cancer recurrence with real-time three-dimensional ultrasonography-based virtual cystoscopy.

This prospective study evaluated the accuracy of grey-scale two-dimensional (2D) ultrasonography and real-time threedimensional (3D) ultrasonography-based virtual cystoscopy for detecting early recurrence of bladder cancer in previously treated patients (n = 40). Real-time 3D ultrasonography-based virtual cystoscopy images were compared with both 2D ultrasonography and interval conventional cystoscopy pathology results. Ultrasound examinations were performed before routine follow-up with conventional cystoscopy. Overall sensitivity for real-time 3D ultrasonography-based virtual cystoscopy was lower than for 2D ultrasonography, indicating it did not provide additional information. The results of combined (2D and 3D) ultrasonography and conventional cystoscopy differed significantly. Where lesions were detected with combined ultrasonography, the number of previous cystoscopies was lower and the tumour stage was significantly higher at initial diagnosis, compared with cases where no lesions were detected. The results suggest that ultrasonography before cystoscopy can be performed more frequently - or, if no lesions are detected by ultrasonography, the interval between cystoscopies can be prolonged - in patients at high risk of bladder cancer recurrence.

Blunted nocturnal fall of blood pressure in isolated clinical hypertension.

OBJECTIVE: The aim of the study is to assess the relation between diurnal blood pressure variations and target organ damage in isolated clinical hypertension (ICH). MATERIAL AND METHODS: Ninety patients with ICH (clinical systolic blood pressure [SBP] superior or equal to [>=] 140 and/or diastolic blood pressure [DBP]> = 90 mm Hg) and ambulatory daytime SBP and DBP <135/85 mm Hg were enrolled in this study. Patients with ICH were classified into two groups as dippers (13 males, 34 females) and nondippers (7 males, 36 females). Nondippers were defined by a reduction in mean blood pressure of less than 10% from day (06:00-24:00) to night (24:00-6:00); and the rest of the patients were classified as dippers. Left ventricular mass index (LVMI) and early diastolic velocity/late diastolic velocity (e/a) were determined by echocardiography; intima-media thickness (IMT) and compliance of the carotid artery (distensibility coefficient [DC] and compliance coefficient [CC]) were measured by ultrasound. Renal function was measured by glomerular filtrate rate (GFR) and urinary albumin excretion (UAE). Retinal changes were determined by fundoscopy. RESULTS: There was no difference between the demographic and biochemical characteristics of the two groups. IMT was significantly higher in nondippers (p <0.005). The nondippers had significantly lower levels of DC (p <0.005) and CC (p <0.0005). LVMI was above normal in both groups with no significant difference. The e/a ratio, although normal in both groups, differed significantly between them (p <0.0005). HTRP, microalbuminuria and GFR <90 mL/min/1.73 m2 were more frequent in nondipper ICH patients. CONCLUSION: The results of the study suggest that in ICH nondipping is associated with a decrease in arterial compliance. The global risk load for target organ.

Lower extremity venous pathology mimicking deep vein thrombosis: 2 case reports.

We report two cases of lower extremity venous pathology mimicking deep vein thrombosis (DVT). The first case was a 20-year-old male with swelling in the left leg. Colour Doppler ultrasound (CDUS) demonstrated a continuous flow pattern, and computed tomography (CT) revealed compression of the dilated left common iliac vein by the right common iliac artery (May-Thurner syndrome). This dilatation of the vein was caused by overload due to the drainage of the gluteal arteriovenous malformations into this vein. The second case was a 55-year-old female with swelling and pain of the left leg persisting for a year following an operation of a herniated lumbar disk. She was diagnosed as DVT and treated accordingly. Control CDUS performed in our department demonstrated a left iliac arteriovenous fistula and a pulsatile flow pattern in the left femoral vein. CT also confirmed this arteriovenous fistula. We suggest that if not all criteria for the diagnosis of DVT are fullfilled by CDUS, another imaging modality such as multidetector CT should be used.

Enteroclysis findings of intestinal Behcet disease: a comparative study with Crohn disease.

BACKGROUND: The aim of this study was threefold; to define the enteroclysis (EC) findings of intestinal involvement in Behcet disease (BD), to compare these findings with those seen in Crohn disease (CD), and to determine the relation between the duration of BD and severity of the EC findings. METHODS: From 1997 to 2000, 17 BD and 50 CD cases were examined by EC examination. EC was performed with a 13-F balloon catheter via transnasal entubation. Mucosal and mural changes were evaluated. Statistical analysis was performed with the Mann-Whitney U test to determine the relation between duration of BD and severity of the EC findings. P

Target organ damage and changes in arterial compliance in white coat hypertension. Is white coat innocent?

The aim of this study was to perform an extensive evaluation of target organ status, metabolic abnormalities and hemodynamic alterations in white coat hypertension (WCH). Fifty normotensive (NT), 90 WCH (ambulatory daytime blood pressure < 135/85 mmHg) and 101 hypertensive (HT) subjects underwent extensive biochemical, echocardiographic, fundoscopic examination. In a subgroup study, arterial compliance and intima-media thickness (IMT) were measured by Doppler ultrasound in left common carotid artery. WCH subjects were found to have higher body mass index (BMI) than the NTs (p = 0.042). Left ventricle mass index (LVMI) was greater in the WCHs than the NTs (p < 0.001), but significantly less than the HTs (p < 0.001). Hypertensive retinopathy was observed in the WCHs, but was less severe and rare compared to the HTs (13% vs 27%). Both WCHs and HTs had high levels of urinary albumin excretion (UAE) (p = not significant). Total cholesterol was higher in WCHs than in the NTs (p = 0.04) The distensibility coefficient (DC) of the WCHs was significantly greater than the HTs (p < 0.01), while significantly smaller than the NTs (p < 0.01). The compliance coefficient (CC) of the WCHs was significantly higher than the HTs (p < 0.01), and significantly less than the NTs (p < 0.01). The IMT in the HTs was significantly higher than the WCHs (0.81 +/- 0.05 vs 0.70 +/- 0.04 mm; p < 0.001) and the NTs (p < 0.001). The difference between the NTs and the WCHs was not significant. Our data indicate that patients with WCH represent an intermediate group between NTs and sustained HTs where target organ damage and cardiovascular risk is concerned.

Endovascular management of postpartum massive vaginal bleeding. A case presenting with a pseudoaneurysm following subtotal hysterectomy.

In the management of massive vaginal bleeding resulting from obstetrics and gynecological diseases, the percutaneous endovascular embolization procedures have been widely used in recent years. We report a case of massive vaginal hemorrhage due to arterial pseudoaneurysm formation following postpartum subtotal hysterectomy which was successfully treated via the percutaneous endovascular embolization.

Carotid pulsatility indices in surgical menopause.

A large body of literature is available concerning association of hormone replacement therapy (HRT) and postmenopausal women; to our knowledge, only few publications in purely surgical menopausal women. The aim of this study was to evaluate pulsatility indices (PI) of internal carotid arteries in two groups of surgical menopausal women who underwent HRT vs who did not. Measurements of the PIs of internal carotid arteries in both Groups were performed with color Doppler ultrasound. Measurements of the untreated group (n = 38, mean age = 47.10 +/- 2.45, group 1) were compared to those of treated group (n = 42, mean age = 47.35 +/- 2.37, group 2). A statistically significant increase in PIs of the carotid arteries were observed in Group 1 as compared to Group 2 in post-operative follow-up (p < 0.001). Pre- and post-operative PIs in Group 1 measured at significantly different values pre- and post-operatively (right, 0.73 +/- 0.031 vs 0.80 +/- 0.049; left, 0.73 +/- 0.030 vs 0.80 +/- 0.052) (p < 0.001). No such pre- and post-operative difference in PIs were noted among patients in Group 2 (right, 0.74 +/- 0.046 vs 0.73 +/- 0.044, p = 0.200; left, 0.73 +/- 0.04 vs 0.73 +/- 0.04, p = 0.504). When comparing both groups, no statistical difference was noted pre-operatively (right, p = 0.501; left p = 0.625); however, postoperative PIs did reveal a statistically significant difference (p < 0.05). Pre- and post-operative side-to-side differences in the PIs of internal carotid arteries were not statistically significant (group 1, 0.158 vs 0.211; group 2, 0.152 vs 0.356). In surgical menopausal women, the beneficial effects of HRT are in concordance with previous studies in terms of PI, which were performed with natural menopausal women.

The value of ultrasonography in interrupted inferior vena cava with azygos continuation.

The cardiosplenic syndromes represent a complex set of abnormalities of the thorax and viscera resulting from abnormal folding of the embryo during early development. Anomalies of venous development include interruption of inferior vena cava (IVC), and in combination with situs inversus referred to as the polysplenia syndrome. We present a 23-year-old male previously diagnosed as having a persistent left IVC on venography whereas ultrasonographic examination clearly demonstrated interrupted IVC with azygos continuation along with situs inversus.

Another face of mirror-image artifact.

The physics of ultrasound and mechanisms of artifacts are well-known. In this report, an unusual manifestation of mirror-image artifact (MIA) that is completely different from the real image of the structure, demonstrated during a routine abdominal ultrasonographic examination, is described. There have hitherto been no reports on the ultrasonographic appearance of such a MIA.

Destructive diskovertebral lesions in ankylosing spondylitis: appearance on magnetic resonance imaging.

We report magnetic resonance imaging findings of diskovertebral lesions in a case of ankylosing spondylitis mimicking metastatic and/or infectious disease. Multiple hypointense areas were seen on T1-weighted images corresponding to hyperintense areas on T2-weighted images in dorsal, lumbar, and sacral vertebral bodies and the manubriosternal joint, with accompanying soft tissue masses. Diagnosis was achieved through biopsy, regression of the paravertebral soft tissue masses, later detection of bilateral sacroiliitis on computed tomography, and presence of histocompatibility antigen HLA-B27.

Bone marrow changes adjacent to the sacroiliac joints after pelvic radiotherapy mimicking metastases on MRI.

Radiation-induced changes in the sacroiliac joints mimicking metastases on MR images were evaluated. Twelve patients who received radiotherapy to the pelvic region due to pelvic malignancy were included in the study. All patients had undergone external beam radiation therapy to the pelvic region, and 2 patients received supplementary internal radiation. The changes in the sacroiliac joints were evaluated. Computed-tomography-guided core bone biopsy from the bone marrow was taken from their corresponding MR sections in 5 of the patients. T1 hypointense and T2 hyperintense areas with ill-defined margins in the bone marrow adjacent to the sacroiliac joints were observed in all patients. On bone scintigraphy all the lesions demonstrated increased activity. Other radiological modalities excluded fracture, soft tissue mass, and osseous destruction. Bone biopsies demonstrated peritrabecular fibrosis and inflammatory cell infiltration. Patients receiving radiotherapy to the pelvis may demonstrate T1 hypointense/T2 hyperintense, ill-defined postradiotherapeutic benign changes in the sacroiliac joints. In the absence of any other signs of disease progression and when the imaging pattern is typical, close radiological follow-up should be sufficient to rule out metastases.

Radiological workup in mesenteric cysts: insight of a case report.

Mesenteric cysts are rare intra-abdominal tumors. The absence of characteristic clinical findings makes diagnosis cumbersome. In this report, the significance of the preoperative radiological workup was discussed in an adult patient with a mesenteric cyst. The complete resection of the cyst is treatment of choice.

Dorsolumbosacral agenesis.

Caudal regression is a rare congenital spinal anomaly characterized by partial or total agenesis of the sacral and/or lumbar spine. Sacral and/or lumbosacral agenesis has been well described. However, especially as far as MRI studies are concerned, thoracolumbosacral agenesis has rarely been reported.

Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings.

The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty-four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by chi2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.

Percutaneous embolization in the management of intractable vaginal bleeding.

AIM: To assess the effectiveness of arterial embolization in gynecological malignancies by Polyvinyl Alcohol particles. MATERIAL AND METHODS: Six patients, four with cervix carcinoma, one endometrium carcinoma, and one vaginal metastasis of ovarian carcinoma underwent percutaneous embolization due to intractable vaginal bleeding. As an embolic agent PVA particles were used. RESULTS: Cessation of the bleeding was observed immediately after the embolization. Complete embolization has been achieved in all the patients Recurrent bleeding did not occur in any of the cases. There were no complications related to the embolization procedure. CONCLUSION: Transarterial embolization is a lifesaving procedure in treating intractable vaginal bleeding. PVA particles are effective and it is a simple way in ceasing the hemorrhage due to pelvic malignancies.

Inflammation of vertebral bone associated with acute calcific tendinitis of the longus colli muscle.

We present a case of acute retropharyngeal calcific tendinitis with characteristic findings on radiographic, computed tomography, and magnetic resonance imaging (MRI). To our knowledge, this is the first acute retropharyngeal calcific tendinitis report having inflammation of both the vertebra itself and the longus colli muscle diagnosed on MRI. In patients with neck pain, acute retropharyngeal calcific tendinitis should be kept in mind in the differential diagnosis, even if these patients had vertebral pathological signals on MRI.

Color Doppler ultrasound in subclinical varicocele: an attempt to determine new criteria.

OBJECTIVE: The aim of this study is to determine new criteria in the diagnosis of subclinical varicocele in infertile patients. METHODS: A total of 208 testes in 104 patients who were infertile and had no varicocele on physical examination were studied by color Doppler ultrasonography (CDUS) with classical and new criteria. Population proportion difference test was used to compare two methods. RESULTS: One hundred and fourteen testes were accepted as varicocele negative in the same testes units in both methods. Ninety-four testes were varicocele positive with new criteria while 88 of these 94 testes were diagnosed also varicocele positive with the classical criteria. The value of Z* with population proportion difference test was 0.59 which is less than 1.96, which means the proportion of varicocele detection in two methods did not differ. CONCLUSION: Because a gold standard that defines the presence of a subclinical varicocele has not yet been established, new criteria may be needed. However, our new criteria did not add new information to the diagnosis of subclinical varicocele in infertile patients.