Cerebellar metastasis in squamous cell vulvar carcinoma.

INTRODUCTION: Brain metastasis is rarely seen in gynecologic cancers. It is more rarely encountered in vulvar carcinoma. CASE HISTORY: A 56-year-old postmenopausal women referred our gynecologic oncology unit for the treatment of locally advanced vulvar carcinoma. Twenty-five days after the operation she developed vertigo and nystagmus. Cranial MRI investigation revealed that she had multiple cerebellar metastasis. CONCLUSION: Brain metastasis might be seen in patient with vulvar carcinoma. To the best of our knowledge, this is the first reported case of vulvar carcinoma which developed cerebellar metastasis.

Spectrum of abdominal pathologies detected with CT in long term dialysis patients.

As a consequence of the expanded use of long term hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) treatments and extended life spans, complications of end-stage renal disease and dialysis treatments are being encountered with increasing frequency in these patients. Computed tomography can accurately depict many of the potential complications of end-stage renal disease on dialysis. This article presents the abdominal CT findings of 429 end-stage renal disease patients who are on either hemodialysis or continuous ambulatory peritoneal dialysis treatment.

An uncommon cause of acute abdomen--epiploic appendagitis: CT findings.

Epiploic appendagitis, which is an uncommon cause of acute abdomen, is a benign self-limiting inflammatory process of epiploic appendices. It has primary and secondary types. Computed tomography findings of the primary type are specific but are demonstrated rarely. Herein, we present pre- and post-treatment computed tomography findings of two cases who admitted to the emergency clinic with acute abdominal pain and were diagnosed to have epiploic appendagitis. Follow-up computed tomography features correlated well with clinical improvement.

Computed tomography findings of labyrinthitis ossificans secondary to meningitis: a case report.

A 26-year-old man was admitted to our hospital with chronic left ear drainage. He had a history of meningitis when he was a child. Computed tomography (CT) of the temporal bone showed complete obliteration of the otic labyrinth by sclerotic tissue. Based on CT findings, the patient was diagnosed as labyrinthitis ossificans. Computed tomography is an appropriate method of examination for the identification of labyrinthitis ossificans and is of particular importance for the evaluation of patients before cochlear implantation.

Spiral computed tomography: role in determination of chemical compositions of pure and mixed urinary stones--an in vitro study.

OBJECTIVES: To determine the chemical composition of pure and mixed urinary calculi by multislice helical computed tomography (CT) in an in vitro setting. CT is becoming the preferred radiologic examination in diagnosis and management of calculus disease. The management of calculus disease can be facilitated by ascertaining the stone composition. Unnecessary shock wave treatment could be avoided if the fragility of the stones could be predicted at diagnosis. METHODS: A total of 107 stones (86 pure and 21 mixed) were measured in a multislice helical scanner within an air-filled environment. The scans were performed at two energy levels, 80 kV and 120 kV, with a 1-mm slice thickness. The chemical compositions of the urinary stones were assessed on the basis of the differences in the densities measured in Hounsfield units. The stones were assigned to six different groups according to the density measured in Hounsfield units: uric acid, struvite, cystine, calcium phosphate, calcium oxalate monohydrate, and calcium oxalate dihydrate. RESULTS: The differences in the density measured by multislice helical CT at 120 kV for the six groups of pure stones were statistically significant. The densities of the different regions within the mixed stones were also significantly different statistically from each other. The densities of the different regions measured in the mixed stones were not different from the densities of the corresponding pure stones. This finding supports the idea that different chemical compositions within a stone can be identified by their densities measured by multislice helical CT. CONCLUSIONS: The chemical compositions of both pure and mixed stones can be determined by multislice helical CT in an in vitro setting. The feasibility of in vivo determinations remains to be clarified.

Osmotic demyelination syndrome in end-stage renal disease after recent hemodialysis: MRI of the brain.

OBJECTIVE: Osmotic demyelination syndrome has been reported in patients with end-stage renal disease, but the specific MRI findings in this patient group have not been documented in detail. Our aims were to present the brain MRI findings during an episode after hemodialysis and at follow-up, and to identify possible factors that may contribute to lesion development. MATERIALS AND METHODS: Seventeen patients with osmotic demyelination syndrome who had undergone hemodialysis at least once and had brain MRI examinations were retrospectively reviewed. Neurologic and MRI examinations were performed during a clinical episode. Serum levels of sodium, creatinine, blood urea nitrogen, and glucose were assessed, and serum osmolality and the ratio of blood urea nitrogen to creatinine (BUN:Cr) were calculated. Follow-up MRI was performed in nine cases. Laboratory and imaging findings were evaluated. RESULTS: An altered level of consciousness and convulsions were the most common neurologic symptoms. The pons was involved in 11 patients (65%) and extrapontine sites in 12 (71%). Four patients had dysequilibrium syndrome. Follow-up MRI showed complete resolution in six patients and lesion reduction in three within a short time. The most common biochemical changes at the time of MRI were hyponatremia and low BUN:Cr in the blood. Only one patient showed rapid correction of hyponatremia and a rapid change in osmolality during the acute stage. CONCLUSION: In patients who develop osmotic demyelination syndrome after hemodialysis, the lesions may involve the pons or the pons and extrapontine sites. Most lesions that were followed up resolved rapidly and almost completely, favoring transient edema rather than demyelination. Blood chemistries suggested underlying changes in osmolality, particularly as a result of urea shift from the extracellular fluid.

Central pontine myelinolysis secondary to cytomegalovirus hepatitis in a 10-month-old child.

We present a 10-month-old child with central pontine myelinolysis (CPM) secondary to chronic active hepatitis due to cytomegalovirus (CMV) infection. A total of 35 paediatric cases of pontine and/or extrapontine myelinolysis are reported and, to our knowledge, CPM secondary to CMV hepatitis in an infant has not been previously reported. The MRI findings are highlighted.

Percutaneous introduction of a snare for removal of migrated biliary stents.

This report describes two cases in which proximally migrated Amsterdam-type biliary stents were extracted using transhepatic snare introduction into the bile ducts. In one case, the migrated stent was removed transhepatically via a percutaneous approach, and in the other a combination transhepatic-endoscopic extraction was successful. No complications were encountered. Percutaneous introduction of snare via transhepatic route offers a good alternative to surgery for removal of migrated biliary stents.

Diagnosis of complications in auxiliary heterotopic partial-liver transplant recipients: spiral CT findings.

BACKGROUND/AIMS: Imaging is important after liver transplantation to determine possible complications. The purpose of this study was to evaluate the spiral CT findings in auxiliary heterotopic partial liver transplant recipients and to determine the incidence of these complications with spiral CT imaging. METHODS: Twenty-one patients had auxiliary heterotopic partial liver transplantation at our institution during a two-year period. There were 16 males and five females with an age range of 4-58 years. All graft livers were transplanted to the right subhepatic space. Spiral CT was performed at least once after transplantation in twenty of the patients in order to evaluate vascular structures and determine possible complications. The 5mm and/or 8 mm thick sections were obtained through the abdomen before and after IV-contrast at the portal phase. Spiral CT findings were compared with ultrasonography (n=15), digital subtraction angiography (n=8), percutaneous transhepatic cholangiography (n=3) and laparotomy findings (n=2). RESULTS: Complications were detected in fourteen of the twenty-one patients. Spiral CT detected a total of 19/23 (83%) vascular complications in this study. All biliary complications (100%), 13/16 (81%) parenchymal changes and 14/14 (100%) different forms of fluid collections were also detected by spiral CT. In three patients with focal lesions, the infarcts were detected only by CT. It was not able to detect hepatic artery stenosis and one of the pseudoaneurysms of the hepatic artery. CONCLUSIONS: It is suggested that SCT in particular should be used in the evaluation of biliary complications, fluid collections and parenchymal changes of graft liver. It could be used in combination with other non-invasive imaging methods for evaluation of vascular structures.