Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study.

PURPOSE: We aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU. MATERIALS AND METHOD: Patients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratios, partial pressure of carbondioxide (PaCO2), PEEP, and FiO2 were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected. RESULTS: In all positions, PaO2 value during PP was significantly higher than PaO2 before and after prone position (p = 0.001). PaO2 values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO2 values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO2/FiO2 increases after proning compared to before proning. PaO2/FiO2 during PP were higher compared to before proning ones. PaO2/FiO2 during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO2 levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient. CONCLUSION: We believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.

Desmoplastic infantile ganglioglioma: case report.

Desmoplastic infantile gangliogliomas are very rarely encountered, large supratentorial masses, derived from neuroepithelial origin, which have cystic and solid components and contain cells with astrocytic and ganglionic differentiation. These tumors are benign tumors of childhood that become symptomatic when they reach giant sizes. Sixty cases of desmoplastic ganglioglioma have been reported to date. In the present study, a case of giant desmoplastic infantile ganglioglioma in a 22-month-old patient is presented, which had an aggressive radiological appearance in the midline and presented with atypical symptoms.

Decreased thymus size in full-term newborn infants of smoking mothers.

BACKGROUND: Prenatal exposure to tobacco can have significant effects on infants. The objective was to investigate whether maternal smoking affects the size of the thymus. MATERIAL/METHODS: A group of 50 pregnant women who smoked throughout pregnancy and a control group of 92 non-smoking pregnant women were studied. The full-term newborn babies' length, weight, and head circumference were measured. The size of the thymus was assessed by sonography during the first six hours of life in both the study group and the control group newborns. RESULTS: The results of the anthropometric measurements in respect of length (50.36+/-2.27, 50.15+/-1.40 cm, p=0.51), weight (3.43+/-5.13, 3.57+/-4.38 kg, p=0.07), head circumference (34.47+/-1.22, 34.57+/-0.93 cm, p=0.62), and head circumference/weight ratio ((9.94+/-1.40, 9.79+/-1.16 cm/kg, p=0.50) were not significantly different between the patient and control groups, respectively. The thymic index (Ti) and thymic index/weight ratio (Ti/w) of the newborns of the smoking group were lower than in the controls (8.70+/-5.80 vs. 13.26+/-5.46, p<0.001 and 2.47+/-1.55 vs. 3.69+/-1.43, p<0.001, respectively). Moreover, the birth weight, head circumference/weight ratio, Ti, and Ti/w of the newborns of those smoking more than 10 cigarettes per day were significantly lower than those smoking less than 10 (3.08+/-0.55 vs. 3.58+/-0.45, p<0.001; 10.65+/-1.84 vs. 9.67+/-1.11, p=0.03; 5.95+/-4 vs. 10.25+/-6.12, p=0.01; and 1.82+/-1.08 vs. 2.84+/-1.66, p=0.02, respectively). CONCLUSIONS: These results show that smoking while pregnant has a significant effect on the general involution of the newborn and size of the thymus, which plays an important role in the immune system.

Third metatarsal brown tumor with secondary hyperparathyroidism: an atypical localization.

Brown tumors represent the terminal stage of the remodeling process during primary or secondary hyperparathyroidism. We report the first case of brown tumor on the third metatarsal associated with secondary hyperparathyroidism caused by vitamin D deficiency. Radiography showed an expansile tissue mass in the third metatarsal bone. The diagnosis was suggested by the clinical history and was confirmed by biochemical, radiologic, and histopathologic determinations. After intravenous therapy with calcidiol, 1g/d, her symptoms were relieved. The brown tumor showed regression and ossification during the 3 months after therapy.

Initial temporary misdiagnosis of bronchiectasis following pumpkin seed aspiration.

Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. In this report, the authors present a rare case of temporary bronchiectasis of the left lung due to a long-standing retained foreign body in a child. Interestingly, the whole left lung was affected due to the check valve type of obstruction of the main bronchus. Unexpected, unilateral findings on a chest x-ray or a CT scan could be related to an inhaled foreign body, and any delay in making the diagnosis may result in serious complications.

Intradural herniation of intervertebral disc at the level of Lumbar 1-Lumbar 2.

Intradural disc herniation is a serious and rare complication of intervertebral disc rupture. The preoperative diagnosis of intradural disc herniation is still difficult despite new neuroradiologic investigation possibilities including computerized tomography and magnetic resonance imaging and it is usually diagnosed by during surgery. Here we present an intradural disc herniation case at the level of L1-L2 with accompanying significant myelopathic neurologic deficits. A 50-year-old female patient was admitted to the hospital with pain and weakness in both legs. Her neurological examination revealed paraparesis. Magnetic resonance imaging showed an extruded disc hernia of central localization at the L1-L2 level. She underwent total laminectomy at the level of L1-L2 and her intradural disc fragment was extirpated by microsurgical methods.

Tuberculous sacro-ileitis: two cases and radiological findings.

Infective sacro-ileitis is due to common bacteria, 25% being tuberculosis and 10% brucellosis. Slow progression characterizes joint tuberculosis, an uncommon variant of this disease. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report two cases with tuberculous sacro-ileitis which initially mimicked brucellosis infiltration. Diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of joint and radiological imaging methods such as computerized tomography, magnetic resonance and three-phase bone scan. The current diagnosis and treatment of this condition is discussed based on these cases and a literature review.

Recurrent pulmonary microemboli secondary to primary cardiac hydatidosis.

Primary cardiac hydatid cysts are rarely diagnosed and seldom rupture to lungs via pulmonary vein resulting in multifocal cystic lesions. We report a rare instance of an interventricular hydatid cyst. A 19-year-old patient was admitted with dyspnea and multiple homogenous opacities with different sizes in his chest X-ray and contrast enhanced thorax computed tomography. We considered recurrent pulmonary microemboli, although neither systemic embolisation nor intravascular cyst of pulmonary arteries was detected. Due to extensive distribution of the pulmonary cysts, only the cardiac cyst was taken surgically. The patient remains in our care without any pulmonary improvement despite appropriate medical treatment.

Change of nitric oxide concentration in men exposed to a 1.5 T constant magnetic field.

This study was carried out in order to determine nitric oxide (NO) production immediately after a 1.5 T magnetic field 30 min exposure to an experimental group, comprising 33 healthy young male volunteers aged 18-26 years old. In addition, a control group, comprising 30 healthy male volunteers aged 19-26 years old, was not exposed to the magnetic field and their NO levels were also measured. The experimental group was exposed using a magnetic resonance imaging (MRI) apparatus. Nitrite and nitrate concentrations were determined by UV-VIS spectrophotometer. The results, related to the parameters measured in this study, were analyzed by one-way ANOVA. Total nitrite concentration in post-magnetic field samples was found to be higher than in pre-magnetic field samples (P < .05).

Risk factors associated with gallstone and biliary sludge formation during pregnancy.

AIM: To define the risk factors in gallstone and sludge formation, and to investigate the incidence of gallstone and biliary sludge formation during pregnancy in a group of healthy pregnant women. METHODS: Sixty-nine healthy pregnant women in early gestation and 28 nulliparous healthy controls were enrolled. Gallbladder volumes, gallbladder ejection fraction (GBEF), serum triglyceride and cholesterol levels were determined in both groups. In the pregnant group, repeated measurements were performed immediately after delivery and compared with initial levels. Risk factors, which are associated with gallstone and biliary sludge development during pregnancy, were determined by linear regression analysis. RESULTS: No statistically significant difference was observed in the assessed parameters of pregnant women in early gestation and controls (both P > 0.05). In the pregnant group, gallstone and biliary sludge development during pregnancy were detected in 6.3% and 10.9% of cases, respectively. The detected parameters were significantly higher early after delivery than in early gestation, while GBEF was lower (both P < 0.001). Lower GBEF was the most significant factor (P < 0.001) associated with gallstone and sludge formation during pregnancy, while multiple childbirths was the other (P = 0.04). CONCLUSION: Decrease in GBEF is the most significant risk factor for newly developed gallstone and sludge in pregnant women, while multiple childbirths is the other but less important risk factor.

[The efficacy of botulinum toxin-A in the treatment of hypersalivation in children with cerebral palsy]. / Serebral palsili çocuklarda hipersalivasyon tedavisinde botulinum toksin-A uygulamasi.

OBJECTIVES: We evaluated the efficacy of botulinum toxin A (BTX-A) injection into the submandibular salivary gland to decrease hypersalivation in children with cerebral palsy (CP). PATIENTS AND METHODS: Three children (1 girl, 2 boys; mean age 10; range 7 to 13 years) with CP received BTX-A injections. Due to hypersalivation, two patients dirtied 50 napkins and 5-6 pieces of clothes daily, and one patient dirtied 100 napkins and 8-9 pieces of clothes. The severity of hypersalivation was assessed using the drool rating scale. Injections were performed in the submandibular gland under ultrasound localization and under local anesthesia. The amount of saliva flow at the mouth two hours after the meals and in a duration of 30 minutes was assessed seven times: before the first injection and at different intervals after injections up to 12 weeks. The dose of BTX-A was increased from 5 to 20 units per gland in two patients, while one patient received a standard dose of 20 units. At least 50% reduction in saliva secretion at the end of three months was accepted as a successful outcome. RESULTS: Lower doses of BTX-A were not effective to provide the desired amount of reduction in saliva in two patients. However, application of 20 units resulted in a satisfactory decrease in all the patients. CONCLUSION: In selected patients and with appropriate doses, ultrasound-guided BTX-A injections may improve hypersalivation in patients with CP.

Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip.

Computed tomography measurements were made to quantify the relationship between the anteversion of the acetabulum and femoral neck in 27 early walking age patients (age range; 18-48 months) with developmental dysplasia of the hip. The centre-edge angle and acetabular index were measured in standard pelvis radiographs, and anteversion of acetabulum and femoral neck were measured by use of two-dimensional computed tomography in 25 complete dislocated, 19 subluxated and 10 unaffected hips (a total of 54 hips). The diagnosis of dysplasia, subluxation and complete dislocation of developmental hip dysplasia were determined radiographically using Ishida's criteria. There were statistically significant differences between the three groups for the centre-edge angle, the acetabular index, and acetabulum anteversion. There was no statistically significant difference between the three groups for femoral neck anteversion. The acetabular anteversion was found to be 13.4+/-2.8 degrees (mean+/-SD) in unaffected hips, 16.7+/-1.9 degrees in subluxated hips and 19.8+/-2.5 degrees in complete dislocated hips. There was statistically significant difference between the three groups, with a wide range of acetabular anteversion values noted in all groups (9-26 degrees ). The acetabular anteversion was increased on the dislocated side in each patient and we found no retroverted acetabulum. On the other hand there was no significant difference between the groups with regards to femoral neck anteversion. We conclude that confirming anteversion of the acetabulum and the femoral neck by two-dimensional computed tomography is needed in treatment planning of early walking age patients with developmental hip dysplasia.

Comparison of brucella and non-specific epididymorchitis: gray scale and color Doppler ultrasonographic features.

OBJECTIVE: The aim of this study is to find out if it is possible to differentiate between brucellar and non-specific epididymorchitis by comparing ultrasonography (US) and color Doppler ultrasonography (CDUS) findings. MATERIAL AND METHODS: Fifty-six patients diagnosed to have epididymorchitis both clinically and ultrasonographically were included to study. All of the patients were investigated serologically for brucella. Twenty-eight of those patients were admitted brucella epididymorchitis because of high agglutinations titers for brucella. The other 28 patients were admitted non-specific epididymorchitis because of normal agglutinations titers for brucella. Testicular size, echogenicity, hydrocele, internal echoes and/or septations within hydrocele, and scrotal skin thickness of normal and involved testis were compared by ultrasonography. Besides, pick systolic velocity, end diastolic velocity, resistive index and pick systolic velocity ratio values were measured by bilateral testicular color Doppler ultrasonography in both groups. When the p-value is <0.05, the difference between groups is accepted as statistically significant. RESULTS: Thickening of scrotal skin was seen in 17 of 28 patients with brucella epididymorchitis (BEPO) (67%) and in 25 of 28 patients with non-specific epididymorchitis (NEPO) (89.2%) (p < 0.01). There was no difference between groups regarding presence of hydrocele. However hydrocele seen in all patients was anechoic except for two patients (8.6%). Hydrocele seen in 18 of 22 patients with BEPO and hydrocele had internal echogenicity or septation (p < 0.001). Sizes of testes and epididymis were found to be increased in involved testis compared to normal testis. Testes of all patients with NEPO were homogenous with decreased echogenicity except for five patients (17.8%). However, 23 patients with BEPO (82%) found to have heterogenous testis (p < 0.001). Spectral measurements showed increased PSV and EDV values and decreased RI values in involved sides in both groups. There was statistical significant difference in respect to maximum and minimum flow velocity between two groups (p < 0.05). There was no difference between the two groups regarding RI values. PSV ratio was 3.1+/-1.3 in patients with BEPO and 2.2+/-0.7 in patients with NEPO. CONCLUSION: Heterogenicity, focal echogenicity differences and hydrocele with granularity and/or septation seen in a patient presenting with scrotal infection in brucella endemic areas must rise the possibility of brucellosis rather than NEPO. By this way, effective treatment can commence immediately and complications can be avoided.

Audiological findings in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease. The aim of this investigation was to study the relationship between AS and hearing loss. This study compared 28 patients with AS with 23 age-matched controls. All subjects underwent ENT examination, audiological and acoustic immittance measurements, and auditory brainstem response (ABR) tests. Sensorineural hearing loss was found in 28.6 per cent of the AS patients and in 4.35 per cent of the control group. For hearing levels at 250-500 Hz and 4000-8000 Hz, there was a statistically significant difference between the two groups. Acoustic reflex was not obtained in both ears of four patients and the left ear of one patient. There was a correlation between increase of tympanic volume and limitation in neck movement, between extension of 1-3 interpeak latency and limitation in the neck movement. In conclusion, AS affects the inner ear more than the middle ear.

Late ultrasonographic findings in cases operated for hydatid cyst of the liver.

PURPOSE: The aim of this study was to evaluate and present the images due to surgical intervention and to recurrences in patients who had been operated for hydatid cyst of the liver at least 12 months prior to the imaging process. MATERIAL AND METHODS: A total of 77 patients (46 females, 31 males) with a mean age of 38 years (10-60 years) who had undergone surgical intervention for hydatid cyst of the liver were included in this study. The type and the number of operations were determined by reviewing previous medical records of the patients. Recurrence findings and postoperative images were examined by ultrasonography in all patients. RESULTS: Of the 77 patients, 68 had undergone surgical operation for hydatid cyst of the liver for once, six cases for twice, one patient for three and another patient for four times. Ultrasonographic examination was considered normal in 9 (11.6%) patients. The most frequent finding in the remaining patients was hypoechoic (n=6) and anechoic (n=14) images with a hyperechoic periphery within the operation area. While a coarse heterogenous area was visualized in 12 cases (15.5%), a sole hypoechoic image was present in 10 patients. Recurrence was detected in 9 (11.6%) patients of whom 7 were asymptomatic. While daughter cysts were detected in two recurrent cases; the remaining were unilocular cysts. An omentum image extending to the operation area was detected in 11 patients. Calcification was present in 14 patients, whereas four cases had less common findings of anechoic tubular structures adjacent to the operation area. CONCLUSION: While the liver may seem normal by ultrasonography in the late postoperative period in patients, who had been operated for hydatid cyst of the liver, various images may also be present. These images may be misinterpreted as recurrence or other pathologies. Thus, the radiologist should be familiar with the postoperative ultrasonographic findings of hydatid cyst and should not misinterpret the image of anechoic fluid as recurrence. When in doubt, ultrasonographic follow-up is essential. An early postoperative ultrasonographic examination may be the key point in precluding a misdiagnosis.

Aplasia of the pubic bone in conjunction with hip dislocation.

We describe here unilateral left hip dislocation in a 2-year-old child in conjunction with ipsilateral absence of the pubic bone. He was admitted to our hospital at 1 year of age and diagnosed with teratogenic dislocation of the left hip, aplasia of the left pubic bone, an undescended palpable left testicle and hypospadias. We performed open reduction through an anterior approach with preliminary skin traction for 1 week and spica cast for 3 months. The acetabular index was high both on admission and in the last radiographic control. Computerized tomography demonstrated dysplasia of the acetabulum and absence of the pubic bone. We concluded that the congenital absence of the left pubis was the major cause of the residual acetabular dysplasia. To our knowledge the conjunction of hip dislocation, aplasia of pubic bone and genitourinary anomalies has not been reported in the orthopaedic literature previously.

Pneumatization of the inferior turbinates: incidence and radiologic appearance.

OBJECTIVE: The objective of this work was to determine the incidence and radiologic appearance of pneumatized inferior turbinates (PITs). METHODS: Pneumatized inferior turbinates were investigated among 2500 consecutive cases with coronal paranasal sinus computed tomography (CT) scans that were performed for different reasons between 2000 and 2004. RESULTS: Ten new PIT cases diagnosed with CT were identified. Pneumatization was diagnosed in 2 patients aged 7 and 14 years. Therefore, this is the first time that PIT has been described in the pediatric age group. Complete or incomplete pneumatizations were unilateral in 7 cases and bilateral in 3 cases. In bilateral PIT cases, pneumatizations were asymmetric. In 2 cases, only bulbous parts of the inferior turbinates (ITs) were involved. Inferior turbinate expansion related to pneumatization was not observed in any case. In cases with maxillary sinus communication, axial CT sections revealed a defect on the medial wall of the maxillary sinus. CONCLUSIONS: The incidence of PIT was found to be 1 in 250 cases. It is suggested that most PIT cases may be a result of articulation defects between the maxillary process of the palatine bone and the maxillary bone. In such a situation, the maxillary process of the palatine bone and the nasal process of the maxillary bone, which form the medial wall of the maxillary sinus at the IT level, can attach to the IT separately.