Aydın Bora

Clinical and Magnetic Resonance Imaging Findings of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

Background The aim of this study is to evaluate temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis by magnetic resonance imaging (MRI), jaw clenching force, mouth opening, and Fonseca’s questionnaire, and to establish the relationship between these findings and clinical, radiologic, and laboratory activity parameters that are unique to rheumatoid arthritis. Methods Included in the study were 30 RA patients and 30 healthy volunteers. Jaw clenching force of the entire cases was measured with Istanbul Bite Force Recorder (kg) and the mouth opening was measured with a ruler (cm). Additionally, hand grip forces of patients with rheumatoid arthritis were measured with hand dynamometer (kg). Hand and feet graphs and TMJ MRIs of patients were obtained. MRI findings were classified as normal, mild, medium, and severe. DAS28 and sharp scores of patients were estimated. Sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were checked in the patient group and Fonseca’s questionnaires were filled in. Results A significant difference was not observed between age, gender, and level of education of the groups. Jaw clenching force and mouth opening were established as significantly low in RA group compared to the control group (P < 0.001). A significant correlation was found between jaw clenching force, hand grip force, mouth opening, questionnaire, and MRI findings with the disease duration sharp score, DAS28, and hand grip force of the RA group (P < 0.05). However, a significant correlation was not established with ESR, CRP, and RF (P < 0.001). Conclusions Jaw clenching force, mouth opening, and Fonseca’s questionnaire can be used as parameters pointing to TMJ involvement in patients with RA. Yet, further studies in which TMJ involvement is followed up since the onset of the disease are of necessity.

Comparison of placental elasticity in normal and pre-eclamptic pregnant women by acoustic radiation force impulse elastosonography.

The aim of this research was to study and compare placental elasticity with acoustic radiation force impulse (ARFI) elastography in pre‐eclamptic and normal pregnancies.

Cine phase-contrast MRI evaluation of normal aqueductal cerebrospinal fluid flow according to sex and age

PURPOSE The aim of this study was cerebrospinal flow quantification in the cerebral aqueduct using cine phase-contrast magnetic resonance imaging (MRI) technique in both sexes and five different age groups to provide normative data. MATERIALS AND METHODS Sixty subjects with no cerebral pathology were included in this study. Subjects were divided into five age groups: < or =14 years, 15-24 years, 25-34 years, 35-44 years, and > or =45 years. Phase, rephase, and magnitude images were acquired by 1.5 T MR unit at the level of cerebral aqueduct with spoiled gradient echo through-plane, which is a cine phase-contrast sequence. At this level, peak flow velocity (cm/s), average flow rate (cm/ s), average flow (L/min), volumes in cranial and caudal directions (mL), and net volumes (mL) were studied. RESULTS There was a statistically significant difference in peak flow between the age group of < or =14 years and the older age groups. There were no statistically significant differences in average velocity, cranial and caudal volume, net volume, and average flow parameters among different age groups. Statistically significant differences were not detected in flow parameters between sexes. CONCLUSION When using cine-phase contrast MRI in the cerebral aqueduct, only the peak velocity showed a statistically significant difference between age groups; it was higher in subjects aged < or =14 years than those in older age groups. When performing age-dependent clinical studies including adolescents, this should be taken into consideration.

Primary Alveolar Soft Part Sarcoma of the Scapula

Alveolar soft part sarcoma (ASPS) is an unusual soft tissue malignity, occurring in less than 1% of sarcomas and typically found in the head and neck tissues in children or, in adults, in the deep soft tissues of the lower extremities. In this report, we present a 33-year-old male with primary ASPS in the right scapular bone and discuss the radiologic features of this tumor in the context of the current literature.

Ultrasound Elastography for Distinction Between Parathyroid Adenomas and Thyroid Nodules

The aim of this study was to detect the level of stiffness of parathyroid adenomas and to distinguish them from benign and malignant thyroid nodules using ultrasound elastography with acoustic radiation force impulse imaging.

MRI of omphalopagus conjoined twins with a Dandy-Walker malformation: prenatal true FISP and HASTE sequences

Conjoined twins are an extremely rare congenital malformation without any known genetic predisposition. Omphalopagus twins are the second most common variety of conjoined twins and usually are joined at the umbilicus. We present omphalopagus conjoined twins demonstrated with true FISP (fast imaging with steady-state procession) and HASTE (half- Fourier acquisition single-shot turbo spin-echo) magnetic resonance imaging (MRI) sequences, which showed Dandy- Walker malformation in one of the pair. To our knowledge, this is the first case of conjoined twins with this malformation, which was diagnosed with ultrafast MRI.

Herlyn-Werner-Wunderlich Syndrome: Merits of Sonographic and Magnetic Resonance Imaging for Accurate Diagnosis and Patient Management in 13 Cases

STUDY OBJECTIVE To review the main sonographic and magnetic resonance imaging manifestations of Herlyn-Werner-Wunderlich syndrome, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, and to discuss the value of techniques for its diagnosis and treatment. PARTICIPANTS Thirteen patients with Herlyn-Werner-Wunderlich syndrome referred to our department with acute abdomen were identified for the period from 2009-2012. DESIGN Retrospective chart review. SETTING Two tertiary academic centers. INTERVENTIONS None. MAIN OUTCOME MEASURES The evaluation of the clinical features, ultrasonography and magnetic resonance imaging findings, and the treatment protocols. RESULTS Ultrasonographic evaluation of didelphic or double uterus in 10 and bicornuate-bicollis uterus in 3 patients with hematocolpos or hematometrocolpos associated with agenesis of the ipsilateral kidney revealed the diagnosis. In 10 patients, magnetic resonance imaging provided extra information. In 1 patient, a 25-week pregnancy was additionally detected and follow-up was suggested. Seven patients underwent surgical excision of the septum and drainage of the obstructed vagina. Total hysterectomy and hemicolpectomy were performed in 1 patient with 2 children suffering from severe chronic pelvic pain due to pelvic inflammatory disease. CONCLUSIONS Despite its rarity, accurate diagnosis and morphologic description of Herlyn-Werner-Wunderlich syndrome with radiologic modalities are of importance in relieving the clinical complaints by enabling the suitable surgical treatment to be identified.

Acoustic Radiation Force Impulse (ARFI) elastography quantification of muscle stiffness over a course of gradual isometric contractions: a preliminary study.

AIMS To evaluate the feasibility of quantitative analysis of muscle stiffness by Acoustic Radiation Forced Impulse (ARFI) elastography over a course of graduate isometric voluntary contractions. MATERIAL AND METHODS The stiffness of the bilateral biceps muscle of 13 healthy volunteers was measured in real time by ARFI elastography, while the forearm was in neutral-extended position, 90 degree self-flexed positions and 90 degree self-flexed position, with altered weights ranging from 1 to 8 kg placed on flattened palmar surfaces consecutively. The determined increases in biceps muscle stiffness were measured for both arms and correlated with the loadings weights adopted at progressive trial stages. RESULTS The mean shear wave velocity (SWV) values of biceps muscles in a neutral position, in 90 degree flex position and 90 degree flex position with 1 to 8 kg weights on palmar surfaces were 2.162+/-0.302 m/sec, 3.382+/-0.581 m/sec, and 3.897+/-0.585 to 5.562+/-0.587 m/sec, respectively. Significant correlations between the muscle SWV values and related palmar weights and between the SWV values of right and left sides at different trial stages were identified (r=0.951 and r=0.954, respectively). A mutual propagation path of deep regions to entire areas was described to account for the distribution of increase in stiffness with increases in palmar weights. The confidence of method regarding inter-observer difference was confirmed by the correlation analyses of the results (r=0.998). CONCLUSIONS ARFI elastography is a feasible imaging modality for quantifying the stiffness of isometrically voluntarily contracting muscles.

Hepatic Artery Pseudoaneurysm: Delayed Presentation after a Blunt Trauma

Summary Background Ruptured hepatic artery pseudoaneurysm is a rare condition that is life-threatening if not diagnosed and treated rapidly. We present a case of a spontaneously ruptured hepatic artery pseudoaneurysm that occurred after a blunt trauma, and provide a review of the current literature on this topic. This case study demonstrates a spontaneously ruptured hepatic artery pseudoaneurysm which emerged following a blunt trauma and it also presents current literature studies on the topic. Case Report A man at the age of 34 years with blunt trauma dating back to 1.5 month was admitted to the emergency department of a hospital with hematemesis and epigastric tenderness. He also had a duodenal ulcer, blood in the gastric lumen and a large pseudoaneurysm that developed from the left hepatic artery. Soon after the diagnosis, the patient worsened and underwent distal gastrectomy and cholecystectomy that included removing the bleeding aneurysm. Conclusions Ruptured hepatic artery pseudoaneurysm stands as a deadly condition which has to be diagnosed and managed as soon as possible. Physicians need to take aneurysms of abdominal arteries into consideration after routine diagnostic practises as long as the cause of gastrointestinal haemorrhage is unidentified.

Chiari III malformation with a giant encephalocele Sac: case report and a review of the literature.

A boy was delivered via cesarean section at 37 weeks of pregnancy of a 37-year-old female who was referred to our hospital because of breech presentation. A giant cystic lesion was palpated on the cervical-occipital and upper thoracic regions of the fetus. The skin covering the lesion was intact ( fig. 1 ). There was neither a history of suspicious medication in the pregnancy period nor evidence of maternal infection during pregnancy. The amniotic fluid was stained with meconium. The infant did not cry immediately after birth. He was hypotonic with decreased spontaneous movements and had respiratory distress. On physical examination, the child weighed 2.9 kg. The child’s hematological and biochemical parameters showed no abnormality. On cranial CT, frontal bone scalloping (the lemon sign), a defect at the posterior region of the occipital bone and the C1–C4 vertebras, enlargement of the foramen magnum, and a 130 × 107 × 80-mm encephalocele sac containing cerebral tissues were detected. In addition, there was a 20-mm hyperdense hematoma in the left portion of the herniated parenchyma ( fig. 2 ). Brain MRI showed a defect at the lower occipital/upper cervical region and a large encephalocele sac herniated from this defect, which contained the right cerebral occipital lobe, the bilateral cerebellar Cleland [1] first described Chiari malformation in 1883; however, the first classification and documentation of the entity was accomplished by Hans von Chiari in 1891 [2] . Chiari malformation type III is an extremely rare anomaly, characterized by the herniation of the posterior fossa contents, including the cerebellum, brain stem and fourth ventricle, and in some cases, the upper cervical spinal cord through a low occipital and/or upper cervical osseous defect. Other potentially related anomalies that have been reported include a small posterior fossa, hydrocephalus, syringomyelia, tectal beaking, medullary kinking, low-lying transverse sinuses, heart-shaped incisura, hypoplastic tentorial cerebelli, fenestrated falx cerebelli, concave clivus and petrous bone and corpus callosum dysgenesis [3] . High rates of early mortality and severe neurological deficits in the surviving patient population have been reported. The presence of hydrocephalus and infections, the sizes of the sacs and the nature of their contents, and other related abnormalities are accepted as indicators of an unfavorable prognosis [4, 5] . To our knowledge, approximately 30 cases of Chiari III malformation have been reported in the literature thus far. In this presentation, we demonstrated the computed tomography (CT) and magnetic resonance imaging (MRI) findings of a Received: April 25, 2014 Accepted after revision: July 2, 2014 Published online: September 25, 2014