Akif Sirikci

Management strategy of mycobacterial cervical lymphadenitis.

The objectives of this study were to investigate the typical clinical presentation, diagnosis and treatment of mycobacterial cervical lymphadenitis (MCL). Medical records of 87 patients who were treated for MCL were retrospectively reviewed. Definitive diagnosis of MCL was made when a neck mass persisted for several weeks or months and one or more of the following was obtained: (1) positive mycobacterial cultures from biopsy material; (2) Positive mycobacterial staining of biopsy material; (3) Granulomatous inflammation and caseating necrosis on histopathological examination of biopsy material. Clinical findings were reviewed prior to treatment. The treatment included standard antituberculous medications followed by surgery in which either total excision or selective nodal dissection of the cervical lump was made. Follow-up results are presented. The chief complaint was a cervical mass that was localized mostly to the posterior cervical or submandibular regions. A fistula formation was encountered in 11.5 per cent. All patients recovered from MCL by combined antituberculous drug and surgical treatments. Clinical presentation of the disease and histopathological assessment are important in the diagnosis of MCL as well as in the differential diagnosis of tuberculous and nontuberculous MCL. Utilizing the combined medical and surgical treatment options, both tuberculous and non-tuberculous cervical adenitis can be treated successfully.

Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients

In this study, we aimed to assess the clinical, laboratory and radiological findings of vertebral involvement in brucellosis. Fourteen patients diagnosed with spondylitis and spondylodiscitis due to brucellosis were included in the study. Computed tomography, magnetic resonance imaging, or scintigraphy were used to diagnose the vertebral involvement. The control group consisted of 20 patients with brucellosis but no vertebral involvement. The clinical, laboratory, and radiological findings of both groups were compared. The prevalence of vertebra involvement in brucellosis was found to be 7.5%. Of the 14 study patients, two had thoracic, ten had lumbar, and two had both lumbar and sacral vertebral involvement. The associated pathologies were spondylodiscitis, narrowing in the intervertebral space, inflammation or abscess formation in the paravertebral soft tissue, and osteophyte formation. None of the patients had a collapsed vertebral body, angulation deformity, or inflammation in the epidural space. In conclusion, the possibility of vertebral involvement should be remembered in chronic brucellosis, particularly in elderly patients who present with back pain or tenderness over the spine. A high index of suspicion and clinical, laboratory, and radiological examinations help confirm the diagnosis of vertebral involvement.

Important anatomic variations of the sinonasal anatomy in light of endoscopic surgery: a pictorial review.

Abstract. Advances in surgical techniques and instrumentations, utilization of the imaging tools, and understanding the regional anatomy have served to make functional operations with less complications in the paranasal sinus area. In the context of this article, some of these anatomical structures and their variations were reviewed through images. These structures were as follows: course of the anterior ethmoidal artery; roof of the ethmoid; lamina papyracea; uncinate process; optic nerve; and internal carotid artery.

Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms

In this study, we aimed to assess anatomical relationship between the anterior inferior cerebellar artery (AICA) and cochleovestibular nerve (CNV) in patients with non-specific cochleovestibular symptoms using magnetic resonance imaging (MRI). One-hundred and forty patients with non-specific neuro-otologic symptoms were assessed using cranial and temporal MRI. Classification was performed according to four different types of anatomical relationship observed between the AICA and CVN. In type 1 (point compression), the AICA compresses only a limited portion of the CVN. In type 2 (longitudinal compression), the AICA approaches the CVN as both traverse parallel to each other. In type 3 (loop compression), the vascular loop of the AICA encircles the CVN. In type 4 (indentation), the AICA compresses the CVN so as to make an indentation in the nerve. The anatomical relationship between the CVN and AICA was encountered in 19 out of 140 (13.6%) patients (20 ears). The VCC was unilateral in 18 patients (94.7%) and bilateral in one patient (5.3%). There was no other vascular structure causing VCC to the CVN except for vertebral artery that was seen in 2 out of 140 patients (1.4%). These were unilateral cases. There were tinnitus, vertigo or dizziness, hearing loss, and both hearing loss and vertigo in 5 (25%), 13 (65%), 1 (5%) and 1 (5%) ears of 20 patients, respectively. There was no relationship between the cochleovestibular symptoms and type of compression (p>0.05). Neurovascular relationship between the CVN and AICA can be imaged properly using MR and MR based classification may help reporting this relationship in a standard way. Although, MR images can show the anatomical relationship accurately, diagnosis of vascular conflict should not be based on imaging findings alone.

Hydatic cyst located intermuscular area of the forearm: MR imaging findings

Hydatid cyst of the skeletal muscle is rare and can pose various diagnostic problems. The authors report the case of a patient with primary hydatid cysts localized to intermuscular area of the forearm, emphasizing the diagnostic value of MRI. To the best of our knowledge, this localization of the hydatic cyst has not been reported to date.

A new approach to the classification of maxillary sinus hypoplasia with relevant clinical implications.

The purpose of this study was to discover the prevalence of maxillary sinus hypoplasia (MSH) and associated malformations. A total of 490 consecutive axial and coronal computerized tomographic (CT) scans of the paranasal sinuses were obtained from patients with chronic sinusitis. CT scans were assessed for the presence of MSH and associated anatomic variations. A new classification of MSH was made, and the diagnostic criteria listed. The frequency of anatomic variations coexisting with MSH was also estimated. MSH was encountered in 21 (4.2%) of the 490 patients. Unilateral types I, II and III MSH were seen in 7 (1.4%), 6 (1.2%) and 8 (1.6%) respectively. MSH was bilateral only in 3 (0.6%) patients, one of which was a bilateral type II. In the remaining two bilateral MSH cases, there was a type II MSH on one side and type III MSH on the other in each patient. Middle conchal pneumatization was the most common coexisting anatomic anomaly in MSH, followed by agger nasi cell, secondary middle concha,paradoxical middle concha and superior conchal pneumatization. A patient with MSH should be carefully evaluated prior to any sinus surgery in order to avoid surgical complications. With precise CT assessments, an MSH can be diagnosed and distinguished from other maxillary sinus anomalies. With the additional criterion of orbital enlargement, and the help of reproducible measurement techniques explained in this study, an objective diagnosis and classification can be made in further investigations of MSH.

Eosinophilic granuloma of the temporal bone.

Histiocytosis X or Langerhans cell histiocytosis (LCH) is a disease that possesses three less distinctive and overlapping states called eosinophilic granuloma (EG), Hand-Schuller-Christian (HSC) disease and Letterer-Siwe (LS) disease. EG is the least severe and localized form of all LCHs and possesses the best prognostic result. A high index of suspicion is required to diagnose the EG, especially when an ear disease is refractory to medical treatment. Early detection is important to manage the EG properly and to minimize the complications or sequels of treatment. Definitive diagnosis of histiocytosis is made by histopathological means and immunohistochemical detection of S-100 and CD1 antigens in the tissue samples. And differential diagnosis of the subgroups is made according to the clinical manifestations such as visceral organ or bone involvement. Surgical excision, radiotherapy and chemotherapy, either alone or in combination, are the main treatment options.

Noninvasive assessment of benign lesions of vocal folds by means of ultrasonography.

Objectives: Although ultrasonography (US) has been widely used in various parts of the body, its application in laryngeal examination has been limited. Our objective was to evaluate the significance of US examination in benign lesions of the vocal folds. Methods: Ultrasonographic examination of the vocal folds was performed in 14 patients in whom benign lesions of the vocal folds had been diagnosed by videolaryngoscopy and microlaryngoscopy. Microlaryngoscopic surgery was performed after US examination. Each lesion was analyzed for the following US features: Shape, size, and echotexture (echogenicity and homogeneity). Results: In total, 16 lesions were diagnosed in 14 patients by means of videolaryngoscopy and microlaryngoscopy. Ultrasonographic examination was capable of diagnosing 14 of the 16 lesions (87.25%). Ultrasonography mainly helped in the diagnosis of sessile polyps, nodules, and leukoplakia that were larger than 2 mm. The lesions were linear hyperechoic, heterogeneous hyperechoic, hypoechoic, and isoechoic if they were leukoplakia, nodules, hemorrhagic polyps, and other polypoid lesions, respectively. The results are better if the diagnosis follows the corresponding US echotexture pattern rather than videolaryngoscopy and microlaryngoscopy. Conclusions: Laryngeal US examination appears to be a useful diagnostic tool for supplementing microlaryngoscopy in the assessment of benign lesions of vocal folds. In contrast to these currently used imaging techniques, anesthesia is not necessary in laryngeal US examination. In addition, US is noninvasive, painless, and much less expensive than the other techniques.

Cerebral venous sinus thrombosis presenting with excessive subarachnoid hemorrhage in a 14-year-old boy.

Cerebral venous thrombosis presenting with subarachnoid hemorrhage (SAH) is very rare. We report a case of cerebral venous sinus thrombosis as an initial manifestation of SAH. A 14-year-old boy was admitted with progressive headache, nausea, vomiting, diplopia, and gait disturbance. Cerebral computed tomography scan showed a widely SAH in the basal cisterns, bilateral sylvian fissures, and anterior interhemispheric fissure. Cerebral angiography was performed to detect any aneurysm in intracranial vasculature as a cause of SAH; however, the totally thrombosed superior sagittal sinus, galenic vein, and straight sinus were the sole abnormal findings.

The Chiari III malformation : an unusual and asymptomatic variant in an 11-year old child

Chiari III malformation is an extremely rare condition, and is characterized by the hindbrain herniation into a low occipital or high cervical encephalocele together with the pathologic and imaging features of the Chiari II malformation. In this report, an unusual variant of the Chiari III malformation was diagnosed in an 11-year-old girl. She had an encephalocele operation when she was a newborn, and has been asymptomatic since then. The clinical and imaging findings of this case were presented.