Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children's testicular blood flow.

OBJECTIVE: We have compared conventional Color Doppler (CD) and Power Doppler (PD) techniques, which are used for evaluating the testicular blood flow in small children, and the Superb Microvascular Imaging (SMI), which is a new technique. We have also investigated their contributions to testicular evaluations. PATIENTS AND METHODS: We evaluated blood flow in testicles using a grading system with CD, PD and SMI techniques. We determined the average duration of the three techniques. RESULTS: There was a statistically significant difference between the SMI and CD techniques for all patients (p < 0.001, p = 0.001). When we compared the PD and SMI, either as much or more vascular information was obtained (p = 0.106). There was a statistically significant difference between the application durations of the tests (p < 0.05). CONCLUSIONS: Superb Microvascular Imaging yields more detailed vascular information in blood flow in testicles in small children, than either CD or PD. Furthermore, this technique decreases the duration of the examination at a significant level. Superb Microvascular Imaging may represent an alternative method that can be used safely for evaluating blood flow in the testicles of small children. Additional studies may increase the reliability of SMI.

Non-contrast-enhanced imaging of haemodialysis fistulas using quiescent-interval single-shot (QISS) MRA: a feasibility study.

AIM: To assess the efficiency of a novel quiescent-interval single-shot (QISS) technique for non-contrast-enhanced magnetic resonance angiography (MRA) of haemodialysis fistulas. MATERIALS AND METHODS: QISS MRA and colour Doppler ultrasound (CDU) images were obtained from 22 haemodialysis patients with end-stage renal disease (ESRD). A radiologist with extensive experience in vascular imaging initially assessed the fistulas using CDU. Two observers analysed each QISS MRA data set in terms of image quality, using a five-point scale ranging from 0 (non-diagnostic) to 4 (excellent), and lumen diameters of all segments were measured. RESULTS: One hundred vascular segments were analysed for QISS MRA. Two anastomosis segments were considered non-diagnostic. None of the arterial or venous segments were evaluated as non-diagnostic. The image quality was poorer for the anastomosis level compared to the other segments (p<0.001 for arterial segments, and p<0.05 for venous segments), while no significant difference was determined for other vascular segments. CONCLUSION: QISS MRA has the potential to provide valuable complementary information to CDU regarding the imaging of haemodialysis fistulas. In addition, QISS non-enhanced MRA represents an alternative for assessment of haemodialysis fistulas, in which the administration of iodinated or gadolinium-based contrast agents is contraindicated.

Clinical utility of hepatic-perfusion computerized tomography in living-donor liver transplantation: a preliminary study.

BACKGROUND: Vascular complications are a primary diagnostic consideration in liver transplant recipients, with an overall incidence of 9%. Cross-sectional imaging techniques provide information regarding vascular structure and luminal patency but can not quantitatively assess hepatocyte damage in the liver graft parenchyma. Perfusion computerized tomography (CT) is a recently developed method that allows for quantitative evaluation of hemodynamic changes in tissue. Our objective was to evaluate the clinical utility of perfusion CT in assessing vascular complications during living-donor liver transplantation (LDLT). METHODS: The 33 recipients were divided into 3 groups according to Doppler ultrasonographic findings: hepatic arterial complication group, portal venous complication group, and hepatic venous complication group. Blood volume (BV), blood flow (BF), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI) were calculated for the affected vascular territory regions. RESULTS: Compared with normal liver parenchyma, BV, BF, ALP, and HPI were significantly lower in the hepatic arterial complication group. Although PVP and BV were significantly lower, ALP, HPI, and BF were higher in the affected vascular territory region than in normal liver parenchyma for the portal venous complication group. In the hepatic venous complication group, PVP was significantly higher and BF, ALP, and HPI significantly lower in the affected vascular territory regions than in normal liver parenchyma. CONCLUSIONS: Perfusion CT imaging is a noninvasive technique that enables the quantitative evaluation of vascular complications in the graft parenchyma after LDLT and permits a quantitative evaluation of the treatment response.

Association of TNFAIP3 and TNFRSF1A variation with multiple sclerosis in a German case-control cohort.

Variations in two genes of the tumour necrosis factor (TNF) alpha pathway have been implicated in the pathogenesis of autoimmune diseases: polymorphisms in the TNFRSF1A gene, encoding TNF receptor 1, showed significant association with MS in genomewide association scans, and variation in or near the TNFAIP3 gene, coding for a negative regulator of NFkB, was associated with MS, systemic lupus erythematosus, diabetes and rheumatoid arthritis. This study aimed at investigating association of MS with variation in the TNFRSF1A gene as well as in the TNFAIP3 gene region in an independent German case-control cohort. Four hundred and ninety-seven unrelated patients with MS and 878 healthy controls were genotyped with restriction enzyme digestion or TaqMan assays for three polymorphisms in the TNFRSF1A gene and seven in the region of the TNFAIP3 gene. Allele, genotype and haplotype frequencies were compared between cases and controls by chi-square testing. We found significant association of rs10499194, located in the intergenic region upstream of TNFAIP3, with MS (pc = 3.4 × 10(-4) ). Further, the intronic SNP rs1800693 in TNFRSF1A showed moderate association (pc = 0.033) with MS. In conclusion, evidence is accumulating that polymorphisms in both TNFAIP3 and TNFRSF1A genes play a role in MS pathogenesis. Additional studies are warranted to further elucidate the role of TNF pathway variation for MS development.

Transferring innovative freehand SPECT to the operating room: first experiences with sentinel lymph node biopsy in malignant melanoma.

PURPOSE: The purpose of this study was to report on the first experiences with freehand single-photon emission-computed tomography (freehand SPECT) in sentinel lymph node biopsy (SLNB) in patients with malignant melanoma. Freehand SPECT is a novel imaging modality combining gamma probes, surgical navigation systems, and emission tomography algorithms, designed to overcome some of the limitations of conventional gamma probes. METHODS: In this study 20 patients with malignant melanoma underwent conventional planar scintigraphy prior to surgery. In the operating room, the number and location of separable SLNs were detected first by a pre-incisional scan with freehand SPECT to render a 3D-image of the target site and afterwards by a scan with a conventional gamma probe. After SLNB another scan was performed to document the removal of all targeted SLNs. RESULTS: Planar scintigraphy identified 40 SLNs in 26 nodal basins. Pre-incisional freehand SPECT mapped 38 of these nodes as well as one additional node in one patient (95.0% node based sensitivity). The results of freehand SPECT were identical to those of planar scintigraphy in 25 basins, while it missed one basin (96.2% basin based sensitivity). In comparison, the gamma probe failed to detect 7 nodes in 4 basins (82.5% node based sensitivity and 84.6% basin based sensitivity). After resection freehand SPECT detected 9 remaining radioactive spots, two of whichwere resected as they matched the position of SLNs detected on preoperative planar scintigraphy. CONCLUSIONS: Freehand SPECT provides a real-time, intraoperative 3D-image of the radioactive labelled SLNs, facilitating their detection and resection.

A novel index in healthy infants and children - subarachnoid space: ventricle ratio.

BACKGROUND: The subarachnoid space (SAS) and ventricular width (VW) in normal infants and children were studied with ultrasonography to provide the objective measurement and define a normal range for these measurements. The additional aim was to determine the stable ratio as a SAS/VW. MATERIALS AND METHODS: A total of 100 healthy subjects, including 48 males and 52 females, were studied. The cases were divided into 3 age groups: 0-6 months(n = 65), 7-12 months (n = 24) and > 13 months (n = 11). Transfontanel ultrasonography was performed in all the cases. SAS, VW and the SAS/VW ratios were calculated. The study was approved by the ethical committee. All parents were informed about the sonographic examination and their approvals were taken. RESULTS: SAS was calculated as 3.1 (0.5-6) mm and VW was calculated as 3.6(1.3-5) mm. SAS/VW ratio was 0.9 ± 0.3. There was no statistically significant difference among SAS, VW and SAS/VW ratios in 3-97 percentile group (p > 0.05). CONCLUSIONS: Ultrasonography can be used as a practicable and reproducible modality in the measurement of SAS and VW in healthy children. It is a non-invasive method and allows for serial follow-up. SAS/VW ratio can be used as an index in healthy children.

Normative size evaluation of internal auditory canal with magnetic resonance imaging: review of 3786 patients.

BACKGROUND: A narrow internal auditory canal (IAC) is significantly associated with congenital sensorineural hearing loss. It would therefore seem likely that any patient with an IAC measured radiographically to be under the normal range represents an abnormality and probable IAC stenosis. If narrow IAC is diagnosed with routine magnetic resonance imaging (MRI), then the cochlear nerve may be evaluated with special MRI studies. However, there is no consensus in the literature on the normal measurements of the IAC or on what parameters should be used to determine narrow IAC using MRI. In this study, we aimed to assess the normative size of IAC in normal-hearing ears and to determine whether canal size varies with age and gender using MRI. MATERIAL AND METHODS: A retrospective review was undertaken from 2010 to 2012. A total of 7572 normal-hearing ears of 3786 patients were assessed, who had MRI due to various reasons except hearing loss. Patients under 20 years old and over 60 years old were excluded, and the subjects were divided into 4 groups at 10-year intervals. All subjects were divided by gender also. Anteroposterior (AP) and craniocaudal (CC) measurements were obtained in the middle of the IAC on axial and coronal images of 1.5-T MRI. RESULTS: The mean age was 42 years (range 20-60 years). The mean IAC diameters were 5.93 mm with a standard deviation of 0.25 mm (max 6.99 mm, min 4.73 mm) on AP measurements and were 5.70 mm with a standard deviation of 0.26 mm (max 6.82 mm, min 4.71 mm) on CC measurements. There were no differences in the IAC diameters between males and females or with age groups. CONCLUSIONS: These measurements should provide a normative reference for comparison in radiographic assessment of any patient with suspected IAC stenosis. This measurement can help the diagnosis of narrow IAC. To our knowledge, this is the first study using MRI with a large group of patients in the literature.

Characteristics of articular fossa and condyle in patients with temporomandibular joint complaint.

OBJECTIVES: To investigate the temporomandibular joint (TMJ) characteristics of patients who have temporomandibular disorder complaints with multislice computed tomography imaging. PATIENTS AND METHODS: Between January 2011 and March 2012, 37 patients whose age ranged from 18 to 60 years underwent Computed tomography imaging of the bilateral temporomandibular joints for TMJ complaints at our Institution. Twenty one patients without temporomandibular joint complaints serves as control group. Differences between the mean depths of the right and left side mandibular fossa and comparisons between patient and control groups were assessed by analysis student t test. RESULTS: The age range of 37 patients (28 females and 9 males) was 18 to 60 (mean age: 37.5) years. The mean depths of the mandibular fossa were 8.56 ±0.8 mm and 8.71 ±0.7 mm for the right and left sides (p < 0.05). The mean anterior joint spaces were 1.92±0.6 mm and 2.10±0.7 mm for the right and left sides, respectively (p > 0.05). The mean superior joint spaces were 2.98±0.7 mm and 2.82±0.8 mm for the right and left sides (p > 0.05). The mean posterior joint spaces were 2.31±0.7 mm and 2.17±0.6 mm for the right and left sides, respectively (p > 0.05). The mean values for the measurement of the anteroposterior (AP) diameter of the condylar process were 7.56±1.1 mm for the right side and 7.23±1.3 mm for the left side (p > 0.05). The mean values for the measurement of the mediolateral (ML) diameter of the condylar process were 16.97±2.1 mm for the right side and 17.17±2.7 mm for the left side (p > 0.05). CONCLUSIONS: Measurements of mandibular fossa and joint space had not differ in patients of TJS (temporo joint space). But, AP and ML measurements of condyles were statistically difference between patients and controls.

First Experiences with Navigated Radio-Guided Surgery Using Freehand SPECT.

BACKGROUND: Sentinel lymph node biopsy (SLNB) in melanoma using one-dimensional gamma probes is a standard of care worldwide. Reports on the performance are claimed by most groups to successfully detect the SLNs during the surgical procedure in almost 100% of the patients. In clinical practice, however, several issues remain which are usually not addressed: the difficulty of intraoperative detection of deeply located nodes, SLN detection in obese patients or in the groin and the impossibility to make a scan of the entire wound after SLN resection to avoid false negative testing for eventually remaining SLNs. MATERIALS AND METHODS: The concept behind freehand SPECT is to combine a gamma probe as used for conventional radio-guided surgery with a tracking system as used in neurosurgical navigation. From this combination and a proper algorithm framework the 3D reconstruction of radioactivity distributions and displaying these intraoperatively is possible. CONCLUSION: In summary, the feasibility of freehand SPECT could be shown and provides an image-guided SLNB and a truly minimally invasive and optimized surgical procedure.

Effects of Enterococcus faecium supplementation and floor type on performance, morphology of erythrocytes and intestinal microbiota in broiler chickens.

1. The experiment was to study the effects of floor type and probiotic supplementation (Enterococcus faecium) on performance, morphology of erythrocytes and intestinal microbiota of male Ross 308 broiler chickens. 2. The experimental design was a factorial 2 × 2 with 6 replicates. The factors were floor type (wire floor versus wood shaving litter) and the presence or absence of probiotic. 3. Birds housed on wood shavings exhibited significantly improved weight gain and food intake. 4. Addition of E. faecium led to significantly decreased food intake and gizzard weight. Supplementation with E. faecium positively influenced the ileal and caecal microbiota, with a significant decrease in the population of Escherichia coli. 5. Erythrocyte length decreased and erythrocyte width increased in the birds housed on wood shavings.

Radon concentrations in water in the region of Tokat city in Turkey.

The aim of this study is to measure the radon ((222)Rn) concentrations in drinking water and river water in the region of Tokat city in Turkey. The measurements were performed by analysing the water samples collected from tap water, spring water and Yesilirmak river water flowing through the centre of the city of Tokat. The obtained radon concentrations ranged from 0.48 ± 0.22 to 1.30 ± 0.27 Bq l(-1) in tap water, from 0.13 ± 0.17 to 1.20 ± 0.29 Bq l(-1) in spring water and from 0.09 ± 0.12 to 0.83 ± 0.17 Bq l(-1) in the Yesilirmak river water. The results are presented and compared with other studies. From these data, the average effective dose equivalent from radon in tap water and in spring water has been estimated as 5.0 and 3.0 µSv y(-1), respectively.

Guillain-Barré syndrome associated with Legionnella infection.

This is the first report of Guillain-Barré syndrome (GBS) related to Legionnella pneumophilia infection. A 13-year-old boy presented with acute dysphagia and dyspnea. He lived in a rural area and had a history of drinking potable deep-hole water. The patient was intubated because of increased respiratory distress. A positive direct fluoresein antigen test confirmed L. pneumophilia infection in BAL. One week after the first admission, acute weakness was noticed including the lower extremities and was more prominent in the distal than the proximal portions. GBS was considered as the initial diagnosis. Tests for all causes known to trigger GBS were negative. Specific serology for L. pneumophilia IgG was positive. He was treated with intravenous immunoglobulins and discharged with minor weakness and difficulty in walking in the second month. On the basis of this case, L. pneumophilia should be included in the etiologic spectrum of GBS.

Quantitative magnetic resonance imaging of brainstem volumes, plaques, and surface area in the occipital regions of patients with multiple sclerosis.

PURPOSE: To determine brainstem volumes, number of plaques, and surface areas in the occipital lobes of patients with relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), and to investigate whether there is any correlation between brainstem volume and the number/surface areas of plaque in the occipital lobes. MATERIAL AND METHODS: Magnetic resonance imaging was obtained on 14 relapsing-remitting (RR) and 13 secondary progressive (SP) MS patients and 26 female control subjects. The Cavalieri method was used by modern design stereology to measure brainstem volume. The point-counting grid was used to evaluate sclerotic plaque surface areas in the occipital lobe. The number of plaques in the imaging section was calculated. RESULTS: Brainstem volumes for RR and SP with multiple sclerosis and control subjects were 3647 mm3, 3515 mm3, and 4517 mm3, respectively. Mean number of plaques in the right-left occipital lobe was found to be 2.7-3.4 in RR-MS and 5.2-2.8 in SP-MS. Mean plaque surface area in the right-left occipital lobe was determined to be 58.52-88.24 mm2 in RR MS and 124.3-64.82 mm2 in SP MS. Brainstem volumes were significantly reduced in both groups of patients with MS compared to controls (P < 0.01). CONCLUSION: Magnetic-resonance-estimated volume and surface area values in multiple sclerosis may facilitate our understanding of the clinical situation of patients and provide a simple index for evaluating therapeutic efficiency.

Imaging of diaphragmatic rupture after trauma.

Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented.

Thrombogenetic effect of facet denervation using in disc surgery on spinal radicular arteries: an experimental study.

BACKGROUND: Although it is well known that electric current can be hazardous for living tissues, facet denervation (FD) has been largely used in spine surgery. In spite of the fact that vascular structures are protected during the operation, some neurovascular disorders may develop after surgery. In this study, we investigated if FD can cause lesions of the radicular arteries. METHODS: Seventeen rabbits were included in this study. Three of them were used as control group and the remainder were subjected to L4-5 discectomy. FD was applied via monopolar electrocauterization to only half of the operated animals. One month after the surgery, all animals were sacrificed and the L4-5 spinal radicular arteries examined histopathologically. RESULTS: Vascular wall injury, endothelial necrosis, muscular lesions and thrombus development were seen in the majority of the spinal radicular arteries of the animals subjected to FD. CONCLUSION: Facet denervation via monopolar electrocautery may cause arterial lesions and thrombus development in the radicular arteries and therefore it should not be applied unless obligatory.

Unbiased estimation of tumor regression rates during chemoradiotherapy for esophageal carcinoma using CT and stereology.

SUMMARY. The purpose of the present study is to estimate tumor volumes of 10 patients with esophageal carcinoma on serial CT images that are obtained before and after chemoradiotherapy using a stereological method. In this study, tumor volume was measured using the Cavalieri method of modern design stereology with a combination of three separate stages. Firstly, detailed systematic series of axial CT images of 1-cm thickness were obtained throughout the whole tumor area of each subject and to magnify them all CT images were projected on a screen by overhead projector and then were marked by manually tracing the outline of areas with tumor on serial CT images that are projected onto the screen. Secondly these images were drawn on paper. Finally the images on paper were evaluated with a point-counting method. It was shown in a pilot study analyzed that 100 test points counted on about 6--8 serial slices through for esophagus wall, lumen and wall + lumen are sufficient to secure coefficient of error (CE) on the estimates of volumes as in this study. It was found that tumor volumes before and after radiotherapy for esophagus wall, lumen and wall + lumen was 10.34 cm(3), 1.15 cm(3) and 11.75 cm(3) before and 5.93 cm(3), 1.43 cm(3) and 7.65 cm(3) after radiotherapy, respectively. When only esophagus wall and lumen volumes or wall + lumen volumes before and after radiotherapy were statistically compared, the difference between either esophagus wall (P<0.01) and lumen (P<0.01) volumes or total volumes (P<.1) were significant. It is concluded that CT estimated tumor volumes may be helpful in both evaluating the clinical situation of patients and providing a simple index to assess the efficiency of therapy, prediction of tumor regression rate and minimizing the risk of chemoradiotherapy damage.

Carotid intima-media thickness: is it correlated with stroke side?

OBJECTIVE: The objective of the present study was to investigate the possible correlation between the common carotid artery (CCA) intima-media thickness (IMT) and the infarct side. METHOD: The CCA IMTs in patients with atherosclerotic non-lacunar stroke were measured. RESULTS: The mean age of the patients was 64.3 +/- 10.7 years (range 40-83 years) and 42 of 100 patients were male. The infarcts were at the left side in 53 patients and at the right side in 47 patients. The mean CCA IMT was 1.02 +/- 0.18 mm at the infarct side and 0.87 +/- 0.17 mm at the contralateral side. The difference between them was statistically significant (P < 0.01). Although the mean age of the patients with a left-sided infarct was greater than that of the patients with a right-sided infarct, the difference was not statistically significant. CONCLUSION: Our results suggest that CCA IMT may be used in prediction of possible infarct side, and in the prediction of potential risk of stroke by evaluating the IMT of both CCAs separately.

An investigation of the effects of hydroxyapatite coatings on the fixation strength of cortical screws.

Hydroxyapatite (HA) are commonly applied to orthopaedic implants for acceleration of osteointegration and so overcoming the loosening problems such as in cortical screws. Electrophoretic deposition (EPD) of hydroxyapatite was applied for coating of cortical screws in this work. The effects of hydroxyapatite-coated and uncoated cortical screws on insertion and extraction torque were investigated through in vivo experiments. Three groups of screws were undertaken: first group with no coating, second group coated with HA and the third group coated with HA+interlayer, a synthetic calcium silicate compound. Five sheep were operated, and 60 cortical (20 x 3) screws from those of groups were implanted in cortical femurs to observe the effect of HA and interlayer on screws. Results show that as an alternative to plasma spray coating method, the EPD process enables to produce a quick, easy, cheap and uniform adjustable coating layer. Also from biomechanical and SEM examinations, HA coating by EPD method of cortical screws resulted in extremely improved fixation with reduced risk of loosening problem.

Trichoptysis caused by intrapulmonary teratoma: computed tomography and magnetic resonance imaging findings.

We describe a 9-year-old child with a history of trichoptysis caused by intrapulmonary teratoma and we present the CT and MRI findings of the teratoma. A heterogeneous mass containing cystic and solid elements was detected on both CT and MRI scans. Histopathological examination confirmed the diagnosis of teratoma. Teratomas arising from lung parenchyma, as in this case, are extremely rare in childhood. In the thoracic region, the most common localization of teratomas is the anterior mediastinal compartment. We also discuss the CT and MRI findings and the differential diagnosis of teratomas.

Angulation, length, and morphology of the styloid process of the temporal bone analyzed by multidetector computed tomography.

PURPOSE: To investigate the angulation, length, and structural variations of the styloid process (SP) by multidetector computed tomography (MDCT). MATERIAL AND METHODS: MDCT scans were performed in 283 cases (127 M and 156 F, age range 18-77 years). The length of the SP and its angulation on the transverse and sagittal planes were measured. Structural variations of the SP were observed by means of three-dimensional (3D) and multiplanar reconstruction (MPR) images. RESULTS: The length of the bony SP on both sides varied from 0 to 62 mm (mean 26.8 +/- 10.0 mm). Angulation ranged between 55 degrees and 90.5 degrees (7 2.7 +/- 6.6) in the transversal plane and between 76 degrees and 110 degrees (93.5 +/- 6.9) in the sagittal plane. Morphologically, the SP showed a considerable amount of variation. A solitary SP was present in 168 individuals (59.4%). In 9 individuals (3.1%), the SP was duplicated (4 unilateral and 5 bilateral). Sixty-one persons (21.6%) showed an incomplete ossified SP (42 unilateral and 19 bilateral), whereas in 7 individuals (2.5%) a bony SP was absent entirely (7 unilateral). In 38 individuals (13.4%), the stylohyoid ligament was ossified (16 entirely, 22 partial). In all individuals, 3D and MPR images showed the SP in its entire length. CONCLUSION: MDCT with 3D CT and MPR of SP may show further detailed information related to SP. Not only the length of the SP, but also its 3D orientation, should be in focus in anatomical and clinical studies.