Alev Akdilli

Surgical approaches to antrochoanal polyps in children

Antrochoanal polyps (ACP) represent 4-6% of all nasal polyps in the general population, but this proportion increases to 33% in the pediatric group. The aim of this study is to discuss clinical and radiological findings, and some different surgical approaches with their results in the pediatric patients. This study consists of eight children with ACP diagnosed by means of clinical examination, nasal endoscopy and computed tomography. One patient was treated only with simple polypectomy. In five patients, transcanine sinuscopy (TS) was added to functional endoscopic sinus surgery. Four of the patients underwent anterior ethmoidectomy and uncinectomy. Middle meatal antrostomy was applied to two of them. No recurrence was encountered within 5-30 months. The decision for the appropriate type of surgery for ACP is influenced by factors such as patients age, other accompanying sinus pathologies, recurrence after previous surgery, and the possibility of total excision. In patients carrying the risk of recurrence, it is especially important to remove the polyp completely and manage other sinus pathologies, as well as avoiding an unnecessarily expanded operation. In selected patients, we believe that TS may be adequate in totally removing ACP.

Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children

The purpose of this study is to determine important variations and areas of risk for major complications in paranasal computed tomography (CT). We also made specific measurements for individual differences. This study consisted of 64 children (128 sides). Eleven participants had coronal and axial, and the remaining 53 only coronal CT. The distance of the anterior ethmoidal artery (AEA) and the lamina cribrosa to the inferior turbinate and the orbital roof, and the depth of the lamina cribrosa were measured. The percentages of some of the variations were as follows: upper attachment of uncinate process 25%, freely coursing AEA 43%, aerated anterior clinoids 8%, optic canal bulging 6% and extreme medially coursing carotid canal 3%. The frequencies of some of these variations and the existence of Onodi cells were significantly smaller than compared with adults. Specific measurements varied individually. In conclusion, children deserve more attention while evaluating CT, due to their tiny bony structures.

Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura

Abstract. Henoch-Schönlein purpura, although being a systemic vasculitis, mostly involves skin, gastrointestinal system, joints, and kidneys. Testicular involvement is a rare occurrence. A 7-year-old boy with Henoch-Schönlein purpura developed acute scrotum and was referred to rule out testicular torsion. On gray-scale ultrasonography, the testes and epididymis were slightly enlarged, and had heterogeneous and hypoechoic echotexture. The scrotal wall was thickened as well. Color and power Doppler ultrasonography revealed increased vascularity in scrotal contents. Testicular torsion was excluded and the diagnosis of testicular involvement of Henoch-Schönlein purpura was established. Color Doppler US, together with gray-scale findings, can be useful in the evaluation of Henoch-Schönlein purpura with acute scrotum, excluding testicular torsion and preventing unnecessary surgery.

Power Doppler ultrasonography for the evaluation of skin tumors other than malignant melanoma

Abstract. The purpose of this prospective study was to evaluate the value of power Doppler ultrasonography (PDUS) in assessing the vascularity of skin tumors other than malignant melanoma, and to investigate possible diagnostic criteria to help to distinguish malignant from benign tumors preoperatively. Seventy-one patients with the clinical diagnosis of a skin tumor were initially evaluated by ultrasonography. Then PDUS was performed and the presence and type of vascularity (peripheral or mixed) were investigated. Of the 19 benign and 52 malignant lesions, 3 could not be visualized with US. Forty-nine lesions were found to have vascularity (21 peripheral, 28 mixed-type) on PDUS. Of the malignant lesions, 26 showed mixed and 17 showed peripheral-type vascularity; for benign lesions these numbers were 2 and 4 respectively. The presence of vascularity correlated well with pathological behavior (malignant versus benign) (P=0.00002), width (P=0.0001), thickness (P=0.001), dermal disruption (P=0.0018), and subdermal extension (P=0.002) of the tumor; however, the type of vascularity correlated only with thickness (P=0.014). In relation to malignancy, the sensitivity of the presence of vascularity on PDUS was 88% and the specificity was 63%. These values were 93% and 40% respectively, for the mixed type of vascularity when it was accepted as a feature of malignancy. PDUS may help to distinguish malignant from benign skin tumors during preoperative evaluation.

The diagnostic value of intrarenal colour duplex Doppler ultrasonography in children with lower urinary tract infection.

AbstractBackground. The diagnostic value of Doppler US in infectious disease of the kidney is well documented. Previous studies have demonstrated high resistive indices, especially in tubulo-interstitial diseases. Objective. To evaluate the role of intrarenal colour duplex Doppler US in lower urinary tract infections (UTI). Materials and methods. This prospective study was carried out in 111 children (222 kidneys) (age range 1–180 months). Of the children, 78 were healthy while 33 presented with lower UTI. The resistive indices (RI) were measured from the spectral waveforms obtained from interlobar arteries. Results. No statistically significant difference was found between RI of right and left kidneys in both groups. The mean RI was 0.75 ± 0.07 in patients with lower UTI and 0.71 ± 0.1 in the control group (P < 0.05). In the control group there was an inverse correlation between age and RI (P < 0.05). Conclusions. High RI may be found in lower UTI.

Unusual form of spinal tuberculosis: involvement of atlantoaxial joint

Abstract A 40-year-old woman who had neck pain and weakness in her extremities for 3 months was investigated. Anterior dislocation of atlantoaxial joint was detected on plain film. Epidural soft tissue mass leading spinal cord compression was found at the atlantoaxial joint on MR examination. The odontoid process was destructed as well. The soft tissue mass was isointense with spinal cord and non-homogenous hyperintense to vertebrae on T1-weighted images, and hyperintense on T2-weighted images. The mass was significantly enhancing on the post-gadolinium series. Transoral aspiration and culture of aspirated material confirmed that the soft tissue mass was a tuberculous abscess. Isolated atlantoaxial involvement of tuberculosis is exceedingly rare but carries a risk of compression of the upper spinal cord. Clinical picture and radiological findings were discussed.