Brain metabolite alterations in Eisenmenger syndrome: Evaluation with MR proton spectroscopy.

OBJECTIVE: Eisenmenger syndrome (ES) is a life-threatening disease characterized by pulmonary hypertension and cyanosis in patients with congenital heart diseases. The aim of this study was to determine the brain metabolite changes in Eisenmenger syndrome compared with a control group using MR proton spectroscopy. METHODS AND MATERIALS: The study included 10 children (3 male, 7 female) with congenital heart diseases and a diagnosis of Eisenmenger syndrome. The control group consisted of 10 healthy volunteer children. All were examined with a 1.5T MRI scanner and single voxel spectroscopy was performed to obtain spectra from three different regions; left frontal subcortical white matter, left lentiform nucleus and left thalamus. Peak integral values obtained from the spectra were used as quantitative data. RESULTS: The ages of the children with ES were between 5 and 16 years, and between 5 and 15 years in the control group. Periventricular white matter hyperintensities were observed in 3 patients. On MR spectroscopy study, significantly lower levels of Choline metabolite (Cho) were detected in the frontal subcortical region and thalamus regions of the patients compared with the control group. There was no statistically significant difference between the levels of other metabolites (NAA, Cr, mI and Glx). In the lentiform nucleus, although the average value of Cho in ES patients was lower than that of the control group, it was not statistically significant. CONCLUSION: Cho metabolite was determined to have an important role in brain metabolism in Eisenmenger syndrome patients. Oral Cho treatment may help to extend survival.

Urothelial Carcinoma Concomitant With Malakoplakia In Non-Functioning Nephrolithic Kidneys.

Nephrolithic non-functioning kidney and malakoplakia are major health problems. Kidney function cannot be fulfilled and also this leads to a high risk of development of urothelial neoplasm. We report herein a case of urothelial carcinoma concomitant with malakoplakia in non-functioning nephrolithic kidneys.

Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension.

BACKGROUND AND AIM: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy. SETTING AND DESIGN: Designed as a cross-sectional study. MATERIALS AND METHODS: We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. RESULTS: Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively). CONCLUSIONS: Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.

[Blunt renal trauma in children: a retrospective analysis of 41 cases]. / Çocuklarda künt böbrek travmalari: Kirk bir olgunun geriye dönük olarak degerlendirilmesi.

BACKGROUND: The majority of renal injury secondary to blunt abdominal trauma can be successfully treated conservatively. In the present study, the clinical features and outcomes of children who presented with renal injury secondary to blunt abdominal trauma were evaluated. METHODS: This study was carried out retrospectively using data from children at the Department of Pediatric Surgery who were hospitalized for renal injury due to blunt abdominal trauma between 2000 and 2012. Patient characteristics, clinical presentation, management strategy, and outcome were evaluated. RESULTS: Forty-one patients were hospitalized. The mean age of the patients was 10±4.85 years. The majority of renal injuries were grade 1 and 2. Falling was the cause of most renal injuries. All patients were initially treated conservatively. Three patients underwent acute surgical exploration for life-threatening renal bleeding (grade 4-5 injury). Nephrectomy was performed in 3 patients due to injury to the pedicle. CONCLUSION: The conservative treatment of pediatric renal parenchymal injuries is safe and effective in children. Although the vast majority of renal injuries do not require surgical intervention, life-threatening renal bleeding, regardless of the grade of injury, should be treated surgically.

Joubert syndrome: the clinical and radiological findings.

Joubert syndrome is a rare disease characterised by clinical and radiological findings. Among the classic clinical findings of JS are hypotonia, ataxia, mental-motor retardation, respiratory and opthalmological findings. The paediatric cases included in the study comprised nine patients. There was familial consanguinty in seven cases. Clinically, all cases had mental-motor retardation and hypotonia. Episodic hyperpnoea attacks were observed in one case. Facial dysmorphism was the most common additional systemic anomaly and four cases had additional opthalmic findings. Brain MRI examination revealed that all cases had molar tooth sign, bat-wing appearance and vermian cleft. The majority of cases also had vermian hypoplasia. Cerebellar folial disorganisation was observed in approxiamtely half of the cases. Three cases had corpus callosum anomaly and atretic occipital encephalocoele. No pathology was determined in other organs. This study aimed to evaluate the clinical and radiological findings of 9 patients diagnosed with Joubert syndrome.

Diffusion-weighted MRI of the testes in patients with varicocele: a preliminary study.

OBJECTIVE: This preliminary study aimed to evaluate changes in apparent diffusion coefficient (ADC) values of the testes in patients presenting with varicocele. SUBJECTS AND METHODS: This cross-sectional study included 25 consecutively recruited patients with varicocele and 25 healthy control volunteers. The ADC values were measured in all participants. Kolmogorov-Smirnov tests were used to test the normality of the data distributions, and the data were expressed as arithmetic means and SDs. A one-way analysis of variance with a post hoc Bonferroni test was used to analyze normally distributed continuous data. Independent sample Student t tests were used to compare continuous variables between two groups. Furthermore, a Pearson correlation coefficient analysis was used to examine the association of venous diameters with mean ADC values in patients with varicocele. A two-sided p value < 0.05 was considered statistically significant. Sensitivities, specificities, and areas under the curve were calculated for the ADC values. RESULTS: The ADC values associated with the ipsilateral testicular parenchyma of patients with varicocele were found to be lower than those of healthy volunteers. Moreover, the ADC values of the contralateral testicular parenchyma in patients with varicocele were also lower than those of healthy volunteers. The sensitivity and specificity of ADC values were 90% and 96%, respectively, for patients with varicocele and 89.5% and 96% for healthy volunteers. The mean ADC values were significantly negatively correlated with venous diameter. CONCLUSION: The measurement of testicular ADC values may be used as a diagnostic indicator in the detection of testicular fibrosis.

Forty-five degree wrist angulation is optimal for ultrasound guided long axis radial artery cannulation in patients over 60 years old: a randomized study.

Arterial cannulation is a common anaesthetic procedure that might be challenging and time-consuming in elderly patients. To establish an appropriate wrist joint position for arterial cannulation is crucial for ultrasound (US)-guided cannulation success. This study aimed to find out the optimal wrist joint angle for long axis in-plane (LA-IP) US-guided approach in radial artery cannulation in elderly patients. One hundred patients over 60 years old, who were assumed to require an arterial catheter for continuous blood pressure monitoring or frequent blood gas analysis in the intensive care unit or in the operating room were included in this prospective randomized study. Patients were randomized to five groups according to the wrist positions (0°, 15°, 30° 45° and 60° groups) for LA-IP approach for radial artery cannulation. Cannulation time (s), number of attempts, total success rate (%), first attempt success rate were recorded in all patients. Mean radial artery height was increased in 45° group compared to other groups (p < 0.05). Distance between skin and radial artery in 45° and 60° groups were statistically significantly decreased compared to 0° group (p < 0.05 for all comparisons). Mean cannulation time of 45° group was statistically decreased compared to other groups (p < 0.05). Number of attempts and total success rate were similar among groups, whereas first attempt success rate was significantly increased in 45° group compared to other groups (p < 0.05). Mean arterial height of the first attempt successful group was statistically increased compared to the first attempt failed group (p < 0.001) and mean cannulation time and mean number of attempts were also negatively correlated with arterial height (p < 0.001; for all comparisons). The 45° wrist angle increment might be advantageous in US-guided LA-IP radial artery cannulation in elderly patients in view of cannulation time and first attempt success rate.

Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion.

PURPOSE: We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. MATERIALS AND METHODS: This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. RESULTS: According to Light's criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4-33) was significantly higher than that of the transudates (median, 5; range, 2-15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CONCLUSION: CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation.

[Complex regional pain syndrome type 1 after fracture of distal phalanx: case report]. / Distal falanks kirigi sonrasi kompleks bölgesel agri sendromu tip 1 gelisimi: olgu sunumu.

Complex Regional Pain Syndrome (CRPS) is a disease characterized especially by pain, swelling, limited range of motion, vasomotor instability and patchy bone demineralization in the extremities. In this case, we report a 46-year-old woman diagnosed with CRPS type 1, whose complaints, such as swelling in the left hand, pain, and limitation of movement, started 2 months after a fracture of the distal phalanx in the left 4th finger. Her complaints were reduced with treatment of calcitonin, gabapentin, calcium and vitamin D3, retrograde edema massage, contrast baths, conventional TENS, pulsed ultrasound, desensitization and exercise with range of joint motion. CRPS type 1 should be considered in the differential diagnosis of upper limb pains which start after a fracture of the distal phalanx.

Efficacy of diffusion-weighted magnetic resonance imaging in follow-up patients treated with open partial cystectomy of liver hydatid cysts.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy of DWI in differentiation of patients with residual cavity and type 1 hydatid cyst (HC) in the liver. METHODS: 32 patients were included. 12 of these patients had type 1 HC and the remainders (n = 20) had postoperative residual cavities. In all patients, axial T2-weighted and DWI images were obtained. An apparent diffusion coefficient (ADC) map of the images was automatically generated and the ADC values were measured on this map for all patients. Mann-Whitney U test was used for comparison of continuous variables between two groups. RESULTS: The mean diameters of type 1 hydatid cyst and residual cavity groups were 83.42 mm, 49.30 mm, respectively (P = 0.001). There were no significant differences in gender and age between the groups (both P > 0.05). The mean ADC values of type 1 hydatid cyst and residual cavity groups were 2.58 ± 0.13 × 10(-3) s/mm(2), 2.58 ± 0.16 × 10(-3) s/mm(2), respectively (P = 0.953). CONCLUSION: DWI might not be suitable to differentiate the postoperative residual cavity from the type 1 hydatid cyst in the liver due to similarity of ADC values between postoperative residual cavity and type 1 hydatid cyst.

Anterior interhemispheric calcified lipoma together with subcutaneous lipoma and agenesis of corpus callosum: a rare manifestation of midline craniofacial dysraphism.

Frontonasal dysplasia (FND) or craniofacial dysraphism includes a variety of craniofacial defects. FNDs are rarely associated with intracranial lipoma. The majority of intracranial lipomas are incidentally identified on radiological examinations. They are commonly accompanied by other congenital intracranial malformations. Moreover, they are rarely associated with subcutaneous lipoma. We present a rare case of midline craniofacial dysraphism with interhemispheric calcified lipoma together with subcutaneous lipoma and agenesis of the corpus callosum.

The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis.

This study aimed to evaluate the changes in spleen and liver diffusion-weighted magnetic resonance imaging (DWI) in chronic viral hepatitis patients. The study comprised 47 patients and 30 healthy volunteers. DWIs were obtained. Apparent Diffusion Coefficient (ADC) measurements were made by transferring the images to the workstation. The measurements of value b 1000 were made from a total of five points of the liver and three points of the spleen. Liver biopsy was performed on the 47 patients. The fibrosis stages of the patients were defined according to the METAVIR scoring system. Student's t-test was used in the comparison of mean ages, liver and spleen ADC values between the patient and the control group. Kruskal-Wallis followed by Mann-Whitney U Test with Bonferroni adjustment was performed in the comparison of mean ADC values of the patients at different stages and the control group. A statistically significant difference was determined between the patient and control group in respect of liver and spleen mean ADC values (P<0.05). F3 group showed a significant difference compared to control and F1 and F4 group showed a significant difference compared to control, F1, F2 and F3 group in terms of the mean liver ADC value (P<0.01). F3 and F4 group showed a significant difference compared to control and F1 group in terms of the mean spleen ADC value (P<0.01). As a result we believe that the measurement of liver and spleen ADC values may be an indicator in the determination of the level of fibrosis.

Cervicomediastinal giant cystic hygroma: a case report.

Cystic hygroma is a rare congenital malformation of the lymphatic system. It is most frequently detected in the head and neck region. Ultrasonography is performed as the first step for radiological diagnosis of these lesions. Magnetic resonance imaging provides important information for diagnosis and to guide treatment. In this paper, a case is reported of cervicomediastinal large cystic hygroma in a male infant.

The role of diffusion-weighted magnetic resonance imaging in the classification of hepatic hydatid cysts.

The aim of the study was to classify different types of hepatic hydatid cysts (HHCs) by measuring the mean apparent diffusion coefficient (ADC) using diffusion-weighted magnetic resonance imaging (DWI). This prospective study comprised 44 patients. The 44 HHCs were classified using Gharbi ultrasonographic classification (GUC) and then T2WIs and DWIs were obtained. The ADC values were measured of the hydatid cyst (HC) subtypes. The distribution of the ADC values in the cyst groups was compared using the Kruskal-Wallis test for multi groups and the Mann-Whitney U test for paired groups. To evaluate the efficacy of ADC values in cyst diagnosis, receiver operating characteristic (ROC) analysis was performed. According to the GUC, there were 15 type 1, 11 type 2, 7 type 3, 5 type 4 and 6 type 5 HHCs. According to the ADC values in the paired comparisons, while types 1, 2 and 5 HCs were statistically differentiated from all other groups except the type 3 group, the type 4 group was differentiated from all other groups and the type 3 group was only differentiated from the type 4 group. When two groups were formed from the HHC subtypes with types 1, 2, and 3 in one group and types 4 and 5 in the other, a statistically significant difference was determined in the mean ADC values of these new groups. In conclusion the measurement of ADC values can be considered a promising parameter as an alternative to ultrasonography in the determination of subtypes of HHCs.

Childhood moyamoya disease accompanying Leigh syndrome.

Moyamoya disease is a cerebrovasculopathy of unknown etiology during the course of which the main and terminal veins of the internal carotid artery undergo progressive vein occlusion. Leigh syndrome is a mitochondrial encephalomyopathy that occurs due to "cytochrome c oxidase deficiency" characterized by psychomotor retardation, difficulty in eating, seizures, hypotonia, respiratory disorders and high lactate levels. Many diseases and syndromes have been defined that are associated with Moyamoya disease. To the best of our knowledge, the association of moyamoya disease with Leigh syndrome has not been defined as yet. In this study, the clinical and imaging results of a 3-year-old male child displaying the association of Moyamoya disease and Leigh syndrome are presented.