Ali Koçyiğit

Intima-media thickness of carotid artery and susceptibility to atherosclerosis in obese children with nonalcoholic fatty liver disease.

Objective: To test, via prospective case-control study, whether measurements of carotid artery intima-media thickness (cIMT) reflect the susceptibility to atherosclerosis in obese children with nonalcoholic fatty liver disease. Patients and Methods: In all, 80 obese asymptomatic normotensive adolescents (body mass index [BMI], 29.12 ± 5.13; 8.5–17.5 years) and 30 age- and sex-matched nonobese healthy children (BMI 18.55 ± 2.24). Children were analysed in 4 groups: Controls formed group 1, 26 children with obesity without hepatosteatosis formed group 2, 32 children with grade 1 hepatosteatosis formed group 3, and 22 children with grade 2 or 3 hepatosteatosis formed group 4. The key parameters were BMI, liver function tests, lipid profiles, glucose, hepatic ultrasonography, and IMT of common carotid artery (CCA), left carotid bulbus (CB), and left internal carotid artery (ICA). Results: Comparisons of IMT measurements of left CCA, left CB, and left ICA between controls and obesity group revealed statistically significant differences (each segment P < 0.0001). There was an increase in the mean of IMT of each segment with the increase in hepatosteatosis grade (each segment P < 0.0001). The relation between the mean of IMT of left CCA, left CB, and left ICA with BMI (P = 0.001, r = 0.318), alanine aminotransferase (P = 0.007, r = 0.256), and hepatosteatosis (P < 0.0001, r = 0.470) was significant. Multiple regression analysis between left CCA, left CB, and left ICA, and age, sex, relative weight, alanine aminotransferase, total cholesterol, obesity, and hepatosteatosis grade was significant for only hepatosteatosis grade. Conclusions: The cIMT is significantly higher, increasing susceptibility to atherosclerosis, in obese children with hepatosteatosis than in healthy children or obese children without hepatosteatosis.

Assessment of atherosclerosis in obese adolescents: Positive correlation of mean platelet volume and carotid intima media thickness

This study aims to assess the correlation of mean platelet volume (MPV) and common carotid artery (CCA) thickness in a population of obese adolescents.

Hepatic Artery Resistance in Children with Obesity and Fatty Liver

ObjectiveThe present study assessed whether there is a correlation between hepatic artery resistive index (HARI) and increase of body mass index and hepatosteatosis grading in children with non-alcoholic fatty liver disease (NAFLD) reflecting hemodynamic effects of hepatosteatosis.MethodsThirty three healthy children [body mass index(BMI): mean± standart deviation(SD), min-max: 20.1±1.14(18.5–23.7), 33 overweight [BMI:25.1±2.2 (18.5–23.7)] and 66 obese [BMI:31.1±2(25.6–40)] adolescents were enrolled into the study. To search the relation of HARI with fatty liver degree, study subjects subdivided into groups according to their degree of fatty liver at ultrasonography(US).ResultsIncrease of HARI was correlated with increase in BMI (p<0.0001, r=0.533). Increase of HARI was well correlated with increase in degree of fatty liver (p<0.0001, r=0.630).ConclusionThe present study results suggest that there are positive correlations of HARI with BMI and hepatoseatosis grade in obese children with NAFLD. HARI may be a candidate parameter to determine early alarming hemodynamic changes in hepatic tissue of obese children with fatty liver before development of severe stages NAFLD.

Investigation of Biomechanical Characteristics of Intact Supraspinatus Tendons in Subacromial Impingement Syndrome: A Cross-sectional Study with Real-time Sonoelastography.

ObjectiveThe aim of this work was to evaluate the real-time sonoelastography (RTSE) in the assessment of the supraspinatus tendon in patients with subacromial impingement syndrome (SIS). MethodsTwenty-five patients with unilateral shoulder pain that was diagnosed as SIS according to magnetic resonance imaging findings were included in the study. Healthy shoulders of the patients comprised the control group. Bilateral shoulder RTSE examinations were performed by a radiologist who was blinded to the involved side of the participants. The RTSE images were recorded and assessed by 2 radiologists individually 1 month later. American Shoulder and Elbow Surgery shoulder index, Quick Disabilities of Arm Shoulder and Hand Questionnaire, and Constant scores were applied to evaluate the disability and functional status. The correlation between strain ratio and functional scores were investigated. ResultsOf the 25 participants, 9 (36%) were men and 16 (64%) were women. The RTSE findings were pathologic in tendons of 23 patients (92%) with SIS. The strain ratio was significantly higher in the affected shoulders (P < 0.001). The interobserver agreement was good for image analysis. There was no significant correlation between strain ratio and functional scores. ConclusionStructural changes in the supraspinatus tendon can be demonstrated with RTSE in patients with SIS.

Sonoelastographic strain index in the early diagnosis of plantar fasciitis

Wereadwithgreat interest the recent studypublished inClinical Imaging that reported the utility of real-time elastography in plantar fasciitis and the comments on this article [1,2]. We would like to share our experience with sonoelastographic strain in early diagnosis of plantar fasciitis (PF). A 36-year-old female patient was admitted with left heel pain. She described a sharp, burning pain that exacerbated in the morning and after rest. She had no symptoms on the right heel. Physical examination revealed positive heel compression test on the left side. Left plantar fascia tenderness was detected on palpation. She had no foot deformities. Her calcaneal X-ray was in normal range without any signs of fascial thickening and calcaneal spur formation (Fig. 1a, b). B-mode ultrasonography (US) revealed normal findings for both right and left plantar fascia with a thickness of 0.8 mm and 2.2 mm, respectively (Fig. 2a, b). Given that her plantar fascia was normal according to B-mode US findings, stretching exercises and modification of daily living activities were recommended. On the follow-up visit 2 weeks later, she reported only 25% relief in her symptoms. Real-time sonoelastography (RTSE) was performed to detect early structural changes in the symptomatic plantar fascia with a high-resolution ultrasound device (Logiq E9; GE Healthcare, Milwaukee, WI, USA) equipped with an elastographycompatible 6–15-MHz matrix linear probe. Manual light compression and decompression on to the plantar fascia by the probe were applied attentively to achieve an optimal and consistent color coding shown on the sonography screen. The force applied to the tendonwas adjusted appropriately according to the visual indicator seen on the US 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. The color scale was green, yellow, and red on the left side, whereas it was mostly blue and green on the healthy right side. The strain indexwas 0.4 on the left side, whereas it was 0.1 on the right side (Fig. 3a, b). A higher strain index revealed softening in the symptomatic plantar fascia. Upon RTSE and clinical findings, conservative medical treatment with naproxen 2×275 mg was prescribed for PF. As a novel and dynamic imaging technique, RTSE displays the stiffness of tissues under compression with a color-coded image that lays over the grayscale US image translucently. RTSE may document the

A Hemophagocytic Lymphohistiocytosis Case with Newly Defined UNC13D (c.175G>C; p.Ala59Pro) Mutation and a Rare Complication.

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immuncompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue.

The effect of ultrasonography guided intra-articular corticosteroid injections in advanced knee osteoarthritis

Gönderilme tarihi: 23.02.2015 Kabul tarihi: 16.03.2015 Abstract Purpose: The aim of the study is to evaluate the effect of ultrasonography-guided intra-articular corticosteroid injection on pain, functional status and quality of life in patients with advanced knee osteoarthrit. Materials and methods: 50 knees of 26 patients who were diagnosed as grade 4 knee osteoarthritis according to Kellgren Lawrence classification system were treated with ultrasonography-guided intra-articular injection of 40 mg triamcinolone acetonide. Perceived pain, weekly analgesic consumption, findings of physical examination, knee pain threshold, functional status and quality of life were evaluated before and four weeks after the injection. Western Ontario and McMaster Universities’ (WOMAC) osteoarthritis index was used to assess functional status, and Nottingham Health Profile (NHP) was used to evaluate the quality of life. Results: Mean age of the patients in the study was 65±7.5 years and mean symptom duration was 74.7± 32.5 months. Visual analog scale for pain decreased from 85.3.±14.1 mm to 59, 6±21.1 mm (p=0.003) and mean analgesic consumption decreased from 8±3 to 3±2 (p=0.000). Total WOMAC score (p=0.000) and scores of 4 NHP subdivisions (pain (p=0.000); physical mobility (p=0.003), social isolation (p=0.012); emotional reactions (p=0.016) decreased significantly 4 weeks after the injection. Conclusion: Injection under ultrasonography guidance may improve the beneficial effects of corticosteroids in advanced knee osteoarthritis.