Evaluation of inguinoscrotal pathologies among adolescents with special emphasis on association between varicocele and body mass index.

PURPOSE: To investigate the prevalence of inguinoscrotal pathologies among a stable population in adolescent age and the association between varicocele and some somatometric features. MATERIALS AND METHODS: A computerized database of 12581 candidates for junior officer studentship in a military college examined from 2002 to 2009 was assessed, and prevalence of inguinoscrotal pathologies as well as relationship of varicocele with weight, height, and body mass index (BMI) were evaluated in a relatively stable group regarding the body status. RESULTS: Of the applicants, 1424 (11.32%) were affected by at least one inguinoscrotal pathology. Including patients surgically treated, the most common disease was varicocele (5.96%), 98% of which were left-sided, followed by inguinal hernia (3.85%), predominantly located on the right side (55.5%), and undescended testis (0.76%). Younger applicants were more prone to have lower BMI (P = .0001) and varicocele than the older group (P = .036). The presence of varicocele was significantly associated with height (P = .0001) and inversely correlated with BMI (P = .0001), but not with weight (P = .08). Logistic regression analysis showed that lower age and greater height were significant predictors for the occurrence of varicocele in this relatively homogenous population regarding the somatometric features. CONCLUSION: Varicocele, being the most common inguinoscrotal pathology in adolescent age, was found to be highly correlated with age, height, and BMI.

Gadolinium-enhanced 3D MR angiography of pulmonary hypoplasia and aplasia.

OBJECTIVE: The goal of this study was to determine the role of gadolinium-enhanced 3D MR angiography (MRA) in patients with suspected pulmonary hypoplasia and aplasia in a retrospective analysis of MRA and digital subtraction angiography in 11 patients with clinical and/or radiologic suspicion of pulmonary hypoplasia and aplasia. CONCLUSION: Gadolinium-enhanced 3D MRA is capable of diagnosing pulmonary hypoplasia and aplasia rapidly and accurately. Both pulmonary hypoplasia and aplasia can be shown morphologically in a noninvasive manner, obviating digital subtraction angiography.

[Comparison of right thalamus and temporal cortex metabolite levels of drug-naive first-episode psychotic and chronic schizophrenia in patients]. / Ilaç Kullanmamis Ilk Psikotik Atak Hastalari ile Kronik Sizofreni Hastalarinda Sag Talamus ve Temporal Korteks Metabolit Seviyelerinin MRS ile Karsilastirilmasi.

OBJECTIVE: The aim of this study was to use Magnetic Resonance Spectroscopy (MRS) to investigate whether patients with chronic schizophrenia have different brain metabolite levels in the temporal cortex and thalamus than drug-naive first-episode patients. METHOD: We compared right-handed male first-episode patients (n=13) and chronic schizophrenic cases (n=15) with gender- and handedness-matched controls (n=10). Right temporal and right thalamic N-Acetylaspartate (NAA)/Creatine (Cre), NAA/Choline (Cho), and Cho/Cre ratios were obtained with MRS. RESULTS: Right temporal NAA/Cre, NAA/Cho, and right thalamus NAA/Cre ratios were significantly lower both in the chronic and first-episode patient groups when compared to normal controls (p<. 001), suggesting decreased neuronal integrity in both patient groups. There were no significant correlations between symptom severity and functional status with MRS variables (p=.027). These results suggested that both patient groups had neural integrity problems. Duration of illness (days) in the first-episode patients was significantly correlated with right temporal NAA/Cre and NAA/Cho. CONCLUSIONS: These results suggested that first-episode and chronic patients had significantly impaired neural integrity, particularly in the temporal cortex. It seems that in the acute phase of the first-episode, neural integrity impairment increased along with days elapsed without treatment.

Soft-tissue masses: use of a scoring system in differentiation of benign and malignant lesions.

The purpose of this study was to show the qualitative and quantitative MRI characteristics of soft-tissue masses in differentiation of benign and malignant lesions. A total of 90 soft-tissue lesions were reviewed in this study. The scoring system presents a more objective diagnostic performance in the prediction of benign or malignant masses. With the use of this scoring system, unnecessary biopsy can be precluded in benign lesions.

'Ecstasy'(MDMA)-induced pneumomediastinum and epidural pneumatosis.

Epidural pneumatosis and pneumomediastinum may occur after the inhalation of "Ecstasy" (methylenedioxymetamphetamine), but only one case has been reported in the literature. We report the case of a 21- year-old male patient who presented with epidural pneumatosis and pneumomediastinum. Chest CT demonstrated the pneumomediastinum and multiple air bubbles within the spinal canal.

Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is the preferred treatment of symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC is used to show cystic ducts that are not seen by MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with nonvisualized cystic ducts by MRC. To our knowledge, this is the first study of visualization of cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.

Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is the preferred treatment for symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC was used to show cystic ducts that are not seen on MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with cystic ducts not seen on MRC. To our knowledge, this is the first study of visualization of a cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.

Evaluation of styloid process by three-dimensional computed tomography.

The purpose of this paper was to investigate the length, medial angulations and other structural variants of the styloid process (SP) by three-dimensional computed tomography (3D CT) in patients without any complaints related to elongated SP. We performed temporal computed tomography (CT) scans in 138 cases (87 males, 51 females) with a mean age of 34.5 (17-86). The structure, length and medial angulation of SPs were evaluated on 3D reconstructed images. SP lengths varied between 1.58 and 5.48 cm (average length 2.83 cm), and the angles varied between 60.6 and 84.1 degrees (average angle 69.4 degrees). Other morphological findings were absence of SP (3 unilateral and 1 bilateral), ossification of stylohyoid ligament (9 unilateral and 27 bilateral), irregular SP (5 unilateral and 5 bilateral), fragmentation of SP (12 unilateral and 9 bilateral), absence of the proximal part (5 unilateral and 9 bilateral) and double proximal part (1 unilateral). According to our results, we propose a new classification. Absence of SP, absence of the proximal part of SP, duplication of the proximal part of SP and angle values of SP have never been reported before according to the available medical literature. 3D CT is an effective method in the evaluation of the SP length, angulations and other morphological characteristics.

Type I proatlantal artery with bilateral absence of the external carotid arteries.

During color Doppler examination of a 41-year-old man who presented with vertigo, a right vertebral artery could not be found. Both MR angiography and digital subtraction angiography revealed a large anastomotic vessel between the right internal carotid and vertebral artery. It was thought to be type I proatlantal artery. Furthermore, the external carotid arteries were bilaterally absent. Although each vascular anomaly mentioned above is rare, it even more rare for these variations to occur simultaneously.

Multiple rice body formation in the subacromial-subdeltoid bursa and knee joint.

Multiple rice body formation is an uncommon disorder which resembles synovial chondromatosis both radiologically and clinically. The clinical symptoms are usually non-specific. We report on a pathologically proven multiple rice body formation in both the left subacromial-subdeltoid bursa and knee joint in a 4-year-old girl.

Values of high-resolution computed tomography and pulmonary function tests in managements of patients with chronic hepatitis C virus infection.

AIM: To investigate pulmonary involvement via pulmonary function tests (PFT) and high-resolution computed tomography (HRCT) in patients with chronic hepatitis C virus (HCV) infection. METHODS: Thirty-four patients with chronic HCV infection without diagnosis of any pulmonary diseases and 10 healthy cases were enrolled in the study. PFT and HRCT were performed in all cases. RESULTS: A decrease lower than 80% of the predicted value was detected in vital capacity in 9/34 patients, in forced expiratory volume in one second in 8/34 patients, and in forced expiratory flow 25-75 in 15/34 patients, respectively. Carbon monoxide diffusing capacity (DLCO) was decreased in 26/34 patients. Findings of interstitial pulmonary involvement were detected in the HRCT of 16/34 patients. Significant difference was found between controls and patients with HCV infection in findings of HRCT (chi2=4.7, P=0.003). Knodell histological activity index (KHAI) of 28/34 patients in whom liver biopsy was applied was 9.0+/-4.7. HRCT findings, PFT values and DLCO were not affected by KHAI in patients with HCV infection. In these patients, all the parameters were related with age. CONCLUSION: We suggest that chronic hepatitis C virus infection may cause pulmonary interstitial involvement without evident respiratory symptoms.

CT fluoroscopy-guided percutaneous needle biopsies in thoracic mass lesions.

OBJECTIVE: We aimed to evaluate the usefulness of computed tomographic (CT) fluoroscopy guidance for transthoracic needle biopsies. METHODS AND MATERIAL: CT fluoroscopy-guided biopsies were performed in 81 patients with thoracic mass lesions. Interrupted CT fluoroscopy technique was used with 50-130 mA at 120 kV exposure parameters and slice thickness of 10 mm. We used aspirating needle in 41 patients, cutting needle in 28 patients, and both in 12 patients. We obtained adequate biopsy material in 69 patients at first attempt. Mean fluoroscopy time was 15.17 s and maximum procedure time was 18 min. RESULTS: Adequate samples for pathological diagnosis were obtained in all lesions. Pathological diagnoses were malignant in 41 patients, benign in 27 patients, and suspiciously malignant in 13 patients. There was no significant difference between diagnostic accuracy of the needles in malignant and benign lesions. Complications were observed in 11 patients (13.5%). DISCUSSION AND CONCLUSION: CT fluoroscopy-guided technique provides effective real-time needle biopsy in patients with small tumor size and with tumor located near blood vessels, and in non-compliant patients for diagnosing thoracic lesions.

[A comparison of planar scintigraphy and MRI in the screening of skeletal metastases]. / Kemik metastazi taramasinda Tc-99m-MDP kemik sintigrafisi ile MRG'nin karsilastirilmasi.

PURPOSE: In this study, we aimed to compare magnetic resonance imaging (MRI) and planar scintigraphy findings of patients with known or suspected skeletal metastases. MATERIALS AND METHODS: Twenty eight patients (13 women, 15 men) ranging from 35 to 63 years old, underwent whole body MRI with coronal plane turboSTIR sequence and Tc 99m methylene diphosphonate planar scintigraphy for detecting skeletal metastases. RESULTS: MRI showed metastases in 20 cases, whereas scintigraphy was positive in 23 cases. In 2 patients where scintigraphy showed 4 lesions, MRI showed them to be degenerative changes. In 3 patients scintigraphy showed 4 metastases that were not seen on MRI. In 7 patients extraskeletal metastases were identified by MRI alone. Statistical analysis showed exact correlation between both techniques (Mc Nemar p = 0.25). CONCLUSION: Our results suggest that whole-body MRI is as effective as scintigraphy in skeletal metastases. In the future, developments in MRI technology, increases in the number of MRI units and new studies may make MRI an alternative screening technique to scintigraphy.

Cranial MR imaging findings of potassium chlorate intoxication.

We present the case of a patient who attempted suicide by ingesting matchstick heads (55% potassium chlorate). The patient presented to the emergency room with loss of consciousness, and MR imaging revealed symmetric hyperintense signal within the deep gray matter and medial temporal lobes. The patient improved after undergoing conventional treatment and hyperbaric oxygen.

Sacroiliac joint injections performed with sonographic guidance.

OBJECTIVE: To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra-articular sacroiliac joint injections in patients with sacroiliitis. METHODS: Thirty-four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra-articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. RESULTS: Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra-articular), and 14 (23.3%) were missed. The successful intra-articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. CONCLUSIONS: Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists, this technique is safe, rapid, and reproducible.

Penile metastasis of prostatic adenocarcinoma.

Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.

Mönckeberg's sclerosis: an unusual presentation--a case report.

Calcification of the media of peripheral arteries is referred to as Mönckeberg's sclerosis and occurs commonly in aged individuals. However, it also occurs in younger patients with diabetes mellitus and chronic renal failure. In diabetic patients, medial calcification appears to be a strong independent predictor of cardiovascular mortality. In this report, we have presented a 20 year-old-patient with extensive peripheral artery calcification. The etiology of calcification was not identified. It has been suggested that this was an unusual form of Mönckeberg's sclerosis.

Psoas abscess as a complication of pyogenic sacroiliitis: report of a case.

A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications.