Ahmet Sari

Pituitary dimensions and volume measurements in pregnancy and post partum : MR assessment

Purpose: Our purpose was to clarify and further characterize the changes in height, length, width, volume, and shape in the normal pituitary gland and in width in the infundibulum during pregnancy and the first 6 months post partum. Material and Methods: Cranial MR imaging was performed in 78 women who were pregnant in the second or third trimester or who were post partum, and in 18 age-matched control subjects who were not pregnant. Volume measurements were performed in 2 ways; volume 1=1/2xheightxlengthxwidth; and volume 2=area (measured by trackball)xslice thickness Results: Gland volume, height, width, length, and convexity, and infundibular width increased during pregnancy. the highest values were seen during the 3 days immediately post partum. When compared with volunteers, volumes 1 and 2 showed the largest increase (120%) among the parameters. Gland height showed the best correlation (r=0.94, p>0.00001) with gestational age. the mean height of the gland was 8.76 mm in the third trimester. None of the pregnant women had a gland height of above 10 mm during pregnancy. Only 2 subjects had gland heights of 10.04 and 10.2 mm during the 0–3 days post partum. After this first post-partum period of 3 days, the gland size, shape, and volume and the infundibular width returned to normal within 6 months Conclusion: the pituitary gland enlarges in three dimensions throughout pregnancy. During pregnancy, the volume of the gland shows the highest percentage of increase compared to its length, height, and width. the maximum height of the gland does not exceed 10 mm during pregnancy but it may exceed 10 mm during the 3 days immediately post partum.

Mediastinal lymph nodes: Assessment with diffusion-weighted MR imaging

To prospectively determine whether the diffusion‐weighted magnetic resonance imaging is useful to distinguish between malignant and benign mediastinal lymph nodes.

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses.

OBJECTIVE To assess the utility of percutaneous catheter drainage in the management of tuberculous and nontuberculous psoas abscesses associated without any bony involvement or with minimal bony lesions that could not cause vertebral instability. MATERIALS AND METHOD Eleven patients with psoas, iliopsoas and pelvic abscesses were drained under computed tomography and ultrasonography guidance. RESULTS There were 15 (10 tuberculous, 5 pyogenic) abscesses in 11 patients. Six of the tuberculous abscesses and one of the pyogenic abscess were associated with vertebral involvement. Vertebral lesions were located in one or two vertebrae without causing any serious disturbance in the vertebral stabilization. In one case, the abscess was bilateral. Nine cases were drained under computed tomography guidance, while two cases were drained under both computed tomography and ultrasonography guidance. One session drainage was sufficient for abscess resolution in uniloculated cases. In the two of four multiloculated cases, catheter drainage was performed twice. Relapse of the abscess was found in only one patient. The mean abscess volume was 520 ml and mean drainage duration was 12 days. None of the cases required surgery. CONCLUSION Percutaneous drainage, chemotherapy and additional external brace application with the cases associated with bony lesion may be used for treatment of tuberculous and nontuberculous unilocule and multiloculated abscesses.

Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms

One of the feared complications during detachable coil embolization of cerebral aneurysms is herniation of a coil loop into the parent artery. Although coil protrusion of one or two loops into the parent vessel may not cause adverse events and in some instances can be ignored, the authors believe that coil retrieval is indicated if a free end is seen pulsating along the blood flow stream to prevent migration of the entire coil mass. In one patient, a microballoon was inflated across the neck of the aneurysm during retrieval of a herniated coil to prevent further coil herniation from the aneurysm sac. We present two cases in which prolapsed coils were successfully retrieved either using a microsnare and balloon combination or a microsnare alone. This report focuses on the efficacy of the Amplatz microsnare for such retrievals and the circumstances in which a herniated coil needs to be retrieved. We report two cases in which embolization coils partially migrated into the parent artery during endovascular treatment of cerebral aneurysm and were retrieved using the Amplatz Nitinol microsnare.

VALUE OF RESISTIVE INDEX IN PATIENTS WITH CLINICAL DIABETIC NEPHROPATHY

OBJECTIVE To determine whether the intrarenal resistive index (RI) can be used as a predictor in patients with advanced clinical diabetic nephropathy. METHODS Sixty-eight kidneys belonging to 34 patients with type II diabetes mellitus and 100 kidneys of 50 healthy persons (control group) were evaluated with Doppler ultrasonography. RI values were obtained from intraparenchymal arteries, either the arcuate or interlobar arteries. Patients with diabetes were divided into two groups based on serum creatinine concentration: group 1 (n = 21 patients, 42 kidneys) had a serum creatinine concentration <1.4 mg/dL and group 2 (n = 13 patients, 26 kidneys) had a serum creatinine concentration >1.4 mg/dL. Regression analysis was used to examine the relations between intrarenal RI and age, serum creatinine concentration, and creatinine clearance rate. RESULTS The mean RI value (0.69+/-0.1) in patients with diabetes was significantly different from that of healthy subjects (0.56+/-023) (P < 0.00001). The RI value of the patients in group 2 (0.79+/-0.07) was significantly different from that of the patients in group 1 (0.61+/-0.04, P < 0.00001). Serum creatinine concentration and creatinine clearance rate showed high correlations (r = 0.84 and r = -0.76, respectively) with intrarenal RI values. CONCLUSIONS Because the intrarenal RI shows a high level of correlation with serum creatinine concentration and creatinine clearance rate, it can be used as a predictor in patients with advanced clinical diabetic nephropathy. Intrarenal RI does not offer any advantage over serum creatinine concentration and creatinine clearance rate in patients with early-stage diabetic nephropathy with normal renal function.

Primary intraspinal primitive neuroectodermal tumor: case report of a tumor arising from the sacral spinal nerve root and review of the literature.

Primary spinal primitive neuroectodermal tumor (PNET) is a rare condition, 18 cases of which have been reported in the literature. In general, this tumor is treated with surgery followed by radiotherapy and chemotherapy, but prognosis is still poor. An 18-year-old female patient with an intradural, extramedullary mass at L3–L5 levels is presented in this report. This is the first female patient with primary spinal PNET at lumbar region, second patient with spinal nerve root origin, and third one with intradural, extramedullary localization ever reported in the literature. After surgery, she was treated with craniospinal radiotherapy and four cycles of combination chemotherapy regimen consisting of vincristine, cyclophosphamide, doxorubicin alternated with ifosfamide, and VP-16. Currently, she is asymptomatic and alive at 25 months. The histopathologic, radiologic, and clinical findings of the patient are presented and relevant literature is reviewed.

The One-Month Effects of Topical Betaxolol, Dorzolamide and Apraclonidine on Ocular Blood Flow Velocities in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

Purpose: This double-masked, prospective and randomized clinical trial was planned to investigate with color Doppler imaging the 1-month vascular effects of betaxolol, dorzolamide and apraclonidine treatment on patients with newly diagnosed primary open-angle glaucoma (POAG). Methods: 22 consecutive patients with newly diagnosed POAG between the ages of 46 and 72 years were enrolled in this study. All patients were newly diagnosed cases and had not received any antiglaucoma medication before. Patients who had a systemic vascular disease (including systemic hypertension) or were taking β-blockers, nitrates or calcium channel blockers were excluded from the study. The patients were randomly divided into three groups. Groups A and B contained 7 patients, group C contained 8 patients. Group A patients were treated with topical betaxolol, group B patients received topical dorzolamide eye drops, and group C patients were treated with topical apraclonidine eye drops. Peak systolic velocities (PSV), end-diastolic velocities (EDV) and resistive indices (RI) in the right ophthalmic arteries (OA), central retinal arteries (CRA) and posterior ciliary arteries (PCA) were measured at baseline by using color Doppler imaging on a masked basis. On days 15 and 30 of treatment, the same measurements were repeated. The inter- and intragroup results were compared statistically. Results: Compared to pretreatment measurements, topical betaxolol therapy significantly decreased PSV only in the PCA and only on day 30 of treatment (p = 0.011). On days 15 and 30, dorzolamide decreased RI measurements in the PCA compared to pretreatment measurement (p = 0.013 and p = 0.011, respectively). Apraclonidine also decreased PSV in the OA on days 15 and 30 of treatment when compared to pretreatment values (p = 0.013 and p = 0.012, respectively). When 15-day measurements were compared between the groups, PSV in the OA were significantly higher in dorzolamide-treated patients compared to other groups (p = 0.01 and p = 0.011). On day 30 of treatment, PSV in the OA was also higher in the dorzolamide-treated group than the other groups (p = 0.012 and p = 0.01). Additionally, apraclonidine-treated patients had a significantly lower EDV in the OA than the other groups (p = 0.013 and p = 0.01). The RI in the OA was also significantly lower in the apraclonidine-treated group compared to the other groups (p = 0.01 and p = 0.011). Conclusion: Our study suggests that dorzolamide has the most advantageous 1-month effects on blood flow velocity in the retrobulbar arterial circulation of POAG patients. Betaxolol seems superior to apraclonidine in this regard. Our data may help the clinician when treating patients with POAG medically. Further studies using a larger population size may clarify our results.

Subacute spinal subdural hematoma associated with intracranial subdural hematoma.

We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.

Portal and splanchnic haemodynamics in patients with advanced post-hepatitic cirrhosis and in healthy adults Assessment with duplex Doppler ultrasound

Purpose: to assess portal and splanchnic haemodynamics, and splanchnic vascular resistance in patients with advanced post-hepatitic cirrhosis and in healthy volunteers, by means of duplex Doppler ultrasound (US) Material and Methods: the duplex Doppler US examination was performed in 16 patients with cirrhosis and in 24 healthy volunteers. We investigated vessel diameters, mean flow velocities, and mean blood flows in the portal vein, the superior mesenteric artery (SMA), and the splenic artery (SA), and measured the resistive index values of SMA and SA Results: the mean portal venous blood flow in patients with cirrhosis (829 ± 264 ml/min) was not statistically different from those in the volunteers (734 ± 194 ml/min). the ratio of the SMA and SA blood flows (621 ml/min) to the portal venous blood flow (734 ml/min) was 0.85 in the control subjects. the mean portal venous blood flow (1261 ml/min) and the portal venous velocity (14.6 cm/s) were higher in the patients with recanalized para-umbilical veins than in the volunteers and in the patients without recanalized para-umbilical veins. the SMA and SA blood flows were significantly increased in patients with cirrhosis compared with volunteers. Splanchnic inflow (the sum of the SMA and SA blood flows) was higher than the portal blood flow in patients with cirrhosis except in the subjects with recanalized para-umbilical veins. SMA and SA resistive index values were significantly higher in these patients than in the volunteers Conclusion: Splanchnic blood flow and splanchnic vascular impedance increased significantly in patients with advanced post-hepatitic cirrhosis. Splanchnic inflow must not exceed portal venous blood flow in patients with recanalized para-umbilical veins. Portal vein velocity and portal venous blood flow measurements alone are not useful parameters for discriminating patients with cirrhosis from healthy subjects

Sphenoid sinus brown tumor, a mass lesion of occipital bone and hypercalcemia: An unusual presentation of primary hyperparathyroidism

Brown tumor is a focal lesion of the bone caused by primary or, less commonly, secondary or tertiary hyperparathyroidism (HPT). While the mandible is the most frequently involved bone in the head and neck region, atypical involvement of the cranium in the area of the sphenoid sinus is exceedingly rare. In the literature, a unique case of brown tumor of the sphenoid sinus was reported in a patient with primary HPT. We present a case of sphenoid sinus and occipital bone brown tumor associated with primary HPT. A 47-yr-old woman presented a 2-yr history of headaches, dizziness, diffuse body and articular pain, fatigue, and a 6- month history of intermittent nausea and vomiting, polydipsia, and polyuria. Magnetic resonance imaging (MRI) demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and medial wall of the right orbit, and expansion in the medulla of bone. Examination of biopsy specimens obtained from sphenoid sinus mass confirmed the diagnosis of brown tumor. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of primary HPT. Excision of a parathyroid adenoma affected the metabolic status into normalizing. At the follow-up of 12 months postoperatively, the size of sphenoid sinus brown tumor decreased and the mass of occipital bone disappeared. In conclusion, this is a first report of primary HPT masquerading as a destructive fibrous sphenoid sinus brown tumor associated with a mass lesion of occipital bone and hypercalcemia in the literature.