Baki Yagci

Clinical utility of sonography in diagnosing plantar fasciitis

The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain.

Diffusion-weighted MR imaging of viral encephalitis

IntroductionThe aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of viral encephalitis and its relationship with the stage of the illness.MethodsWe performed conventional magnetic resonance imaging (MRI) including T1-W, T2-W and fluid attenuated inversion recovery (FLAIR) sequences and DWI in 18 patients with viral encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings. Based on the qualitative and quantitative comparison of the conventional MRI and DWI, the patients were divided into three groups. Apparent diffusion coefficient (ADC) values of the involved and contralateral normal brain tissues were computed and compared for each group. The degree of correlation between the time (TI) from the onset of neurologic symptoms to the MR examination and ADC values was determined.ResultsIn group I (n=11) DWI was superior to conventional MRI in detecting the encephalitic involved sites and in depicting the borders of the encephalitic lesions. In group II (n=4) DWI was similar to conventional MRI. In group III (n=3) conventional MRI was superior to DWI. Mean ADC values of affected versus contralateral normal brain tissues were 0.458±0.161×10−3 versus 0.86±0.08×10−3 in group I, 0.670±0.142×10−3 versus 0.93±0.07×10−3 in group II, and 1.413±0.211×10−3 versus 1.05±0.06×10−3 in group III. Patients in group I had significantly lower ADC values than those in group II, while patients in group III had the highest ADC values (P<0.05). The ADC values were significantly lower in the affected sites than in the unaffected sites of patients in groups I and II, but were significantly higher in the affected sites than in the unaffected sites of patients in group III (P<0.05). There was an excellent correlation between ADC values and duration of the disease (r=0.874, P=0.01).ConclusionDWI is superior to other conventional diagnostic MR sequences in the detection of early viral encephalitic lesions and depiction of the lesion borders and, in combination with other sequences, DWI may contribute to the determination of the disease phase.

Doppler waveform of the hepatic veins in an obese population

The objective is to investigate the effect of obesity and hepatosteatosis on the Doppler waveform pattern of the hepatic veins. B-mode and duplex Doppler sonography of the liver and the right hepatic vein was performed in 102 obese subjects and 84 healthy volunteers. The severity of fatty infiltration was graded as mild, moderate and severe. The flow pattern of the right hepatic vein was classified as triphasic, biphasic and monophasic. The Doppler flow pattern in the right hepatic vein was triphasic in 56 (55%), biphasic in 27 (26%) and monophasic in 19 (19%) obese patients, whereas it was triphasic in 83 (99%) and biphasic in 1 (1%) control subject, achieving a statistical significance (Mann-Whitney U-test, P<0.001). There was an inverse correlation between the sonographic grade of the hepatosteatosis and the phasicity of hepatic venous flow (r=−0.67, P<0.001). The hepatic vein pulsatility is significantly dampened in obese patients correlating with the grade of hepatosteatosis. The body habitus itself does not have an independent effect on hepatic venous waveform. The alteration in hepatic vein Doppler flow pattern in an obese population may suggest reduced vascular compliance in the liver because of fatty infiltration.

Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy

BACKGROUND Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature. CASE DESCRIPTION A 22-year-old woman in her 36th week of gestation presented with acute onset of upper back pain and progressive paraplegia. Imaging studies revealed a T4 vertebral hemangioma, which involved the vertebral body, pedincules, transverse, and spinous process with a focal extradural extension of soft tissue component. She underwent emergent cesarean delivery and endovascular embolization, respectively. Her symptoms and neurologic deficits improved quickly. Her complaints restarted 2 years after embolization. Surgical treatment which consists of intraoperative vertebraplasty and segmental fixation was performed. The patients postoperative recovery was excellent. CONCLUSION According to literature review and our patients outcome, pregnancy may induce neurologic symptoms and signs in silent spinal hemangiomas. The way of management is decided by whether the neurologic deficits depend on the deformity caused by hemangioma or some other factors including vascular insufficiency.

Brain stem abscesses in childhood

BackgroundSolitary brain stem abscess is a rare condition with high mortality and morbidity. These lesions were considered to be invariably fatal before 1974 when advanced diagnostic tools were not available. Recently, the diagnosis and prognosis of brain stem abscesses have been modified by the introduction of modern radiological tools, and several patients with a favorable outcome have been reported since then. Because the pons is the most common site of the abscesses, involvement of the sixth and seventh nerves is frequent. The midbrain is the second most likely location, and medullary abscesses are distinctly rare. Treatment of a brain stem abscess includes medical therapy alone, open microsurgical intervention, or stereotactic aspiration.Case reportWe report a case of a 7-year-old girl with a solitary brain stem abscess. Her neurological examination revealed involvement of the cranial nerves and pyramidal tracts. Microsurgical exposure and aspiration of the abscess resulted in rapid improvement in her neurological condition and radiological resolution of the lesion. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment, and we review the relevant literature.

Orbital color Doppler imaging in Behçet’s disease with or without ocular involvement

PurposeTo investigate the value of color Doppler imaging (CDI) of orbital vasculature in the assessment of ocular involvement in patients with Behçet’s disease (BD) without clinical ophthalmologic abnormalities.MethodsCDI of the orbital vessels were performed on 26 eyes of 13 patients who were diagnosed as having BD with ocular involvement (group 1), 65 eyes of 33 patients who had BD without ocular involvement (group 2) and 40 eyes of 20 healthy volunteers (group 3). Peak systolic (PSV) and end-diastolic (EDV) blood flow velocities and resistivity index (RI) measurements were obtained for the ophthalmic artery (OA) and central retinal artery (CRA). The mean velocity of the central retinal vein (CRV) was also measured.ResultsFor the OA, PSV and EDVs were significantly lower and RIs were significantly higher in group 2 than in control subjects. In group 1, only the EDVs of OA were significantly lower than in healthy subjects. For the CRA, PSV and EDVs were significantly lower, and RIs were significantly higher in both BD groups than those in group 3. When group 1 and group 2 were compared, the differences between PSV, EDV and RI measurements for the CRA and OA were statistically insignificant. There was no significant difference in blood flow velocity of the CRV between the three groups.ConclusionMajor hemodynamic changes were observed in the ophthalmic vasculature of Behçet’s patients with or without ocular involvement by CDI. CDI may detect ocular blood flow alterations before initial clinical manifestations.

Serum or plasma cartilage oligomeric matrix protein concentration as a diagnostic marker in pseudoachondroplasia: differential diagnosis of a family

Pseudoachondroplasia (PSACH) is an autosomal-dominant osteochondrodysplasia due to mutations in the gene encoding cartilage oligomeric matrix protein (COMP). Clinical diagnosis of PSACH is based primarily on family history, physical examination, and radiographic evaluation, and is sometimes extremely difficult, particularly in adult patients. Genetic diagnosis based on DNA sequencing, on the other hand, can be expensive, time-consuming, and intensive because COMP mutations may be scattered throughout the gene. However, there is evidence that decreased plasma COMP concentration may serve as a diagnostic marker in PSACH, particularly in adult patients. Here, we report the serum and/or plasma COMP concentration-based differential diagnosis of a family with affected adult members. The mean serum and/or plasma COMP concentrations of the three affected family members alive (0.69±0.15 and/or 0.81±0.08 μg/ml, respectively) were significantly lower than those of an age-compatible control group of 21 adults (1.52±0.37 and/or 1.37±0.36 μg/ml, respectively; P<0.0001). Bidirectional fluorescent DNA sequencing-based genetic diagnosis of these patients revealed a heterozygous mutation for the nucleotide change 1532A>G in exon 14 of the COMP gene, resulting in a substitution of amino acid 511 from aspartic acid to glycine in COMP. Thus, serum and/or plasma COMP concentration may be suggested as an additional diagnostic marker to aid clinical and radiographic findings in suspected cases of PSACH.

A Prenatally Detected Case of Congenital Hepatoblastoma

Hepatoblastoma is a rare tumor of childhood and its incidence in the first year of life is about one in a million. Forty-two congenital hepatoblastoma cases were reported so far. Among 42 congenital hepatoblastoma patients, only seven cases have been detected in the prenatal period. Here we report a rare case diagnosed before birth and confirmed by postmortem autopsy.

Effect of Hormone Replacement Therapy on Clitoral Artery Blood Flow in Healthy Postmenopausal Women

INTRODUCTION Aging and the decline of ovarian hormonal secretion during menopause may alter libido, and sexual response and functioning. The effects of hormone replacement therapy (HRT) on the genital vascular hemodynamics have been widely studied. However, there is a lack of knowledge about the effect of HRT on basal clitoral blood flow. AIM The aims of this study were to measure clitoral artery blood flow and to determine whether HRT has a significant effect in clitoral artery blood flow in postmenopausal women. METHODS Doppler sonography of clitoral arteries was performed in 25 postmenopausal women aged 51.3 +/- 4.5 years who had been using a continuous combined HRT (0.625 mg of conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate, in 1 tablet daily) for 2.0 +/- 1.1 years, and the clitoral artery peak systolic velocity, resistance index (RI), and pulsatility index (PI) were measured. Thirty-five postmenopausal women aged 50.0 +/- 4.2 years who had not used HRT served as a control group. MAIN OUTCOME MEASURES Assessment of clitoral blood flow with color Doppler ultrasonography by measuring the peak systolic velocity, RI, and PI. RESULTS Clitoral artery circulation was easily detectable by the color Doppler sonography. The clitoral artery peak systolic velocities were significantly higher in postmenopausal women taking HRT compared with the control group (11.8 +/- 5.2 cm/second vs. 15.0 +/- 5.4 cm/second, P = 0.025). CONCLUSION HRT improves blood flow to the clitoris. A clitoral blood flow evaluation may be proposed as a potential tool to assess the impact of HRT on the genital tissues and to investigate female sexual response disorders in postmenopausal women.

Clinical significance and renal haemodynamics of incidentally detected retroaortic left renal vein: assessment with venous Doppler sonography

The purpose of this study was to determine whether renal venous pulsations are affected by compression of the left renal vein (LRV) between the aorta and spine, and also to determine the clinical significance of incidentally detected retroaortic LRV. The study population was recruited from 783 consecutive patients undergoing abdominal CT examination for various indications. 22 patients with a retroaortic LRV were prospectively enrolled in this study, and 22 patients without renal disease served as a control group. After measuring the diameters of the central and peripheral portions of the LRV on CT images, the ratio (P/C) and difference (P-C) of the diameters were calculated. Doppler sonography of the interlobar arteries and veins of the left kidney was then performed to obtain impedance indices. Urine analysis of all subjects and scrotal colour Doppler ultrasound of male patients were also performed. The retroaortic LRV diameters were significantly narrower than the pre-aortic LRV diameters (p = 0.002). The left intrarenal venous impedance indices were significantly higher in the patients with retroaortic LRV (p = 0.026) and in the subgroups with P/C>2 (p = 0.020), with P-C>4 mm (p = 0.007) and without nutcracker-like associations (p = 0.006) than in control subjects, but no significant difference was noted between the arterial resistance indices. Haematuria (n = 8), proteinuria (n = 4), varicocele (n = 3) and collaterals (n = 1) were detected in the study group but not in the control group. In conclusion, incidentally detected retroaortic LRV appears to be associated with haematuria, proteinuria, varicocele and altered venous pulsatility. Further investigations are needed to understand the role of venous Doppler ultrasound in the nutcracker phenomenon.