Ali Kocyigit

Functional magnetic resonance imaging of the effects of low-frequency transcutaneous electrical nerve stimulation on central pain modulation: a double-blind, placebo-controlled trial.

Objectives: Transcutaneous electrical nerve stimulation (TENS) is an analgesic current that is used in many acute and chronic painful states. The aim of this study was to investigate central pain modulation by low-frequency TENS. Methods: Twenty patients diagnosed with subacromial impingement syndrome of the shoulder were enrolled in the study. Patients were randomized into 2 groups: low-frequency TENS and sham TENS. Painful stimuli were delivered during which functional magnetic resonance imaging scans were performed, both before and after treatment. Ten central regions of interest that were reported to have a role in pain perception were chosen and analyzed bilaterally on functional magnetic resonance images. Perceived pain intensity during painful stimuli was evaluated using visual analog scale (VAS). Results: In the low-frequency TENS group, there was a statistically significant decrease in the perceived pain intensity and pain-specific activation of the contralateral primary sensory cortex, bilateral caudal anterior cingulate cortex, and of the ipsilateral supplementary motor area. There was a statistically significant correlation between the change of VAS value and the change of activity in the contralateral thalamus, prefrontal cortex, and the ipsilateral posterior parietal cortex. In the sham TENS group, there was no significant change in VAS value and activity of regions of interest. Discussion: We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.

Color Doppler analysis of pelvic arteries following bilateral internal iliac artery ligation for severe postpartum hemorrhage

To compare Doppler blood flow characteristics of the uterine, arcuate, and ovarian arteries of women who underwent bilateral internal iliac artery ligation with those of controls.

Novel splice-site and missense mutations in the ALDH1A3 gene underlying autosomal recessive anophthalmia/microphthalmia

Aim This study aimed to identify the underlying genetic defect responsible for anophthalmia/microphthalmia. Methods In total, two Turkish families with a total of nine affected individuals were included in the study. Affymetrix 250 K single nucleotide polymorphism genotyping and homozygosity mapping were used to identify the localisation of the genetic defect in question. Coding region of the ALDH1A3 gene was screened via direct sequencing. cDNA samples were generated from primary fibroblast cell cultures for expression analysis. Reverse transcriptase PCR (RT-PCR) analysis was performed using direct sequencing of the obtained fragments. Results The causative genetic defect was mapped to chromosome 15q26.3. A homozygous G>A substitution (c.666G>A) at the last nucleotide of exon 6 in the ALDH1A3 gene was identified in the first family. Further cDNA sequencing of ALDH1A3 showed that the c.666G>A mutation caused skipping of exon 6, which predicted in-frame loss of 43 amino acids (p.Trp180_Glu222del). A novel missense c.1398C>A mutation in exon 12 of ALDH1A3 that causes the substitution of a conserved asparagine by lysine at amino acid position 466 (p.Asn466Lys) was observed in the second family. No extraocular findings—except for nevus flammeus in one affected individual and a variant of Dandy–Walker malformation in another affected individual—were observed. Autistic-like behaviour and mental retardation were observed in three cases. Conclusions In conclusion, novel ALDH1A3 mutations identified in the present study confirm the pivotal role of ALDH1A3 in human eye development. Autistic features, previously reported as an associated finding, were considered to be the result of social deprivation and inadequate parenting during early infancy in the presented families.

Parental anxiety and affecting factors in acute paediatric blunt head injury

Objective This study is designed to investigate the factors affecting parental anxiety regarding their children with head injury in the emergency department (ED). Materials and methods This prospective observational study enrolled all consecutive paediatric patients admitted to the university-based ED with the presenting chief complaint of paediatric blunt head injury (PBHI). The parents were asked to respond to the 10-item questionnaire during both presentation and discharge. Anxiety and persuasion scores of the parents were calculated and magnitudes of the decreases in anxiety and persuasion scores were analysed with respect to sociodemographic and clinical variables. Results The study sample included 341 patients admitted to the ED. The anxiety and persuasion scores of mothers and fathers were not significantly different from each other on presentation while the extent of decrease in anxiety scores of mothers were significantly smaller than that of the fathers (p=0.003). The parents’ education levels had significant impact on anxiety and persuasion scores recorded on presentation. The anxiety and persuasion scores were inversely related to education levels of the parents on presentation (p=0.002 and p=0.000, respectively). In addition, lower education levels were found to be associated with a greater decrease in anxiety and persuasion scores. Neurosurgical consultation also affected the magnitude of the decrease in anxiety and persuasion scores of the parents. The changes in the scores were affected negatively by the parents’ age. Conclusions Radiological investigations had no significant impact on the decrease in anxiety and persuasion scores of the parents by themselves, while neurosurgical consultation had significant impact on them. Emergency physicians should tailor their strategy to institute effective communication with the parents of children to cut down unnecessary investigations in PBHI.

Focal herniation of cerebral parenchyma into transverse sinus.

Journal of Neuroradiology - In Press.Proof corrected by the author Available online since samedi 8 novembre 2014

Diffusion weighted magnetic resonance imaging of kidneys in children with vesicoureteral reflux

PURPOSE The apparent diffusion coefficient (ADC) which obtain from diffusion-weighted magnetic resonance imaging (DWI), is a quantitative parameter representing the renal function and parenchymal damage in some renal disorders. The primary aim of this study was to investigate whether renal tissue alterations associated with vesicoureteral reflux (VUR) can be displayed by DWI. The secondary aim was to assess how ADC values change with age in kidneys with and without VUR. MATERIALS AND METHODS This prospective study included 46 patients (8 boys, 38 girls; mean age 7.3 ± 4.2; range 1-15 years) with VUR and 54 control subjects (21 boys, 33 girls; mean age 7.7 ± 5.2; range 1-17 years). All subjects underwent DWI of the kidneys using b value of 600s/mm(2) in addition to MR urography. The ADC values of 71 kidneys with VUR were compared with those of 81 kidneys without VUR. RESULTS The mean ADC values were (1.93 ± 0.36)×10(-3)mm(2)/s, (1.97 ± 0.24)× 10(-3)mm(2)/s, (1.83 ± 0.37)× 10(-3)mm(2)/s, (1.98 ± 0.20)×10(-3)mm(2)/s and (2.08 ± 0.42)× 10(-3)mm(2)/s in normal kidneys, and in those with grade 1, grade 2, grade 3 and grade 4 VUR, respectively. There was no significant difference in ADC values between kidneys with and without VUR. There was a significant positive correlation between the age and ADC values both in kidneys with and without VUR (r=0.79, p<0.001 and r=0.82; p<0.001, respectively). CONCLUSION DWI does not reveal probable parenchymal alterations in reflux nephropathy. ADC values increase with age during childhood not only in normal kidneys but also in kidneys with VUR.

A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; Could we improve CT use in children with mild head injury?

AIM The purpose of our study was to investigate the impact of clinical risk classification on optimization of the rationale of CT scanning in children with mild blunt head trauma. Exposed effective radiation dose values of CT scanning were also evaluated. METHODS Children with isolated pediatric mild head trauma admitted in a single center over a 5-year period (n=3102, >2 years and <16 years of age) were retrospectively reviewed. The study group comprised 806 patients with a mean age of 7.4±2.1 years (range, 2-15 years). The patients were categorized into low and high risk groups with regard to presence of predefined signs and symptoms. Effective radiation dose values were calculated. RESULTS Incidences of the pathologic CT findings related to trauma were significantly different between low (n=10) 1.9% and high (n=90) 29.8% risk groups. Certain predefined signs and symptoms (e.g., vomiting, suspected skull fracture and loss of consciousness) were related significantly with pathologic CT findings attributed to trauma. Estimated mean effective dose values were 3.91±0.38mSv for 2-6 year old (n=557), and 3.33±0.12mSv for 7-16 year old patients (n=349). CONCLUSION The pediatric victims of mild head trauma patients within high risk group and those with vomiting, suspected skull fracture and loss of consciousness should undergo head CT scanning. The manufacturer settings on the CT scanners for children should be revised to alleviate untoward radiation exposure.

Real-time sonoelastography findings of a hypermobile child: a new technique in the assessment of tendon laxity

of our knowledge, there are no imaging methods to document or diagnose joint elasticity in GJH. Nielsen et al. [2] investigated the patellar tendon ultrastructure with transmission electron microscopy in patients with Ehler-Danlos syndrome, GJH, and healthy controls. While they reported a difference between Ehler-Danlos and the control group, they found no difference between GJH and the control group. However, this technique is not a clinically useful and dynamic method to observe the changes in Achilles tendon. RTSE has emerged as a novel and dynamic imaging technique that displays the stiffness of tissues under compression. RTSE images are obtained by comparing the frame-to-frame changes in tissues when a compression force is applied. The results are presented in a colorcoded image that represents the relative stiffness of the tissues within the region of interest as a continuous spectrum changing from red (soft) to blue (hard) [3]. We would like to share RTSE findings of Achilles tendons in a 10-year-old hypermobile boy with GJH (Beighton score, 8/9). RTSE was performed with a high-resolution ultrasound device (Logiq E9, GE Healthcare, Milwaukee, Wisconsin, USA) equipped with an elastography-compatible 12 MHz matrix linear probe. Manual light compression and decompression on to the Achilles tendon by the probe was applied attentively to achieve an optimal and consistent color coding shown on the sonography screen. The force applied to the tendon was adjusted appropriately according to the visual indicator seen on the ultrasonography screen. Each RTSE scan was repeated by compression and relaxation of the scan area several times (at least three compression–decompression cycles) until the findings were confirmed to be reproducible. RTSE demonstrated mostly green and red colored Achilles tendons bilaterally (Fig. 1) which contradicted To the Editor,

Retroperitoneal Bronchogenic Cyst Originating from Diaphragmatic Crura

Bronchogenic cyst is a benign lesion which is commonly seen in the posterior mediastinum. Diaphragmatic origin in retroperitoneum is an unusual location for a bronchogenic cyst. Cross-sectional imaging modalities describe the origin and content of the cyst evidently. Magnetic resonance (MR) images of a 42-year-old male patient who attended ER with back pain revealed a huge retroperitoneal complicated bronchogenic cyst arising from the diaphragm and surrounding the abdominal aorta anteriorly. Bronchogenic cysts in the retroperitoneum rarely originate from the diaphragm and should be kept in mind in the differential diagnoses of abdominal cystic lesions. MR imaging (MRI) is superior to other imaging techniques such as computerized tomography (CT) in detecting the origin and content of these cystic lesions.

Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation?

SUMMARY Brucellosis is an endemic disease in various regions of the world. Testicular abscess is a very rare complication of brucellosis which can be misdiagnosed as a testicular mass and may lead to unnecessary orchiectomy. To our knowledge there are only eight reported cases in the literature of a brucellar testicular abscess. We present a case of testicular abscess due to brucellosis diagnosed with serologic tests and color Doppler sonography, and treated with antibiotics and fine needle aspiration.