Banu Alicioglu

Injuries associated with motorcycle accidents

OBJECTIVES In recent years, there has been a significant increase in motorcycle accidents in parallel with the increasing number of motorcyclists. Data on motorcycle accidents/injuries are relatively limited in Turkey. This study sought to determine the injury profile of patients involved in motorcycle accidents. METHODS This retrospective study included 212 patients (204 males, 8 females; mean age 36+/-16 years; range 2 to 79 years) who were hospitalized for injuries caused by motorcycle accidents. Data on age and sex, injury patterns, length of hospitalization were recorded. Injuries were grouped according to localization. RESULTS The frequencies of injuries in descending order were as follows: musculoskeletal system injuries (n=106, 50%), skull injuries (n=103, 48.6%), maxillofacial injuries (n=38, 17.9%), thoracic (n=15, 7.1%), vertebral (n=10, 4.7%), and abdominal (n=6, 2.8%) injuries. Multiple fractures in upper and lower extremities were seen in 17 (8%) and 43 (20.3%) patients, respectively. The most frequent extremity injuries were tibia-fibula fractures (17.9%) followed by shoulder injuries (11.3%). Both extremity and skull injuries were seen in 23 patients (10.9%). The mean hospital stay was 12.2+/-16.8 days (range 1 to 150 days). Eight patients required intensive care for a mean of seven days. As a complication, one patient (0.5%) with olecranon and tibial plateau fractures developed pulmonary embolism. Motorcycle accidents resulted in mortality in nine patients (4.3%). CONCLUSION Since motorcycle accidents are preventable or associated risks for injuries are reducible, risk factors for our country should be determined, necessary laws and restrictive regulations should be put into practice, and educational programs should be implemented.

Age-related morphologic changes of the vertebral artery in the transverse process. Analysis by multidetector computed tomography angiography

BACKGROUND CONTEXT The V2 segment of the vertebral artery (VA) ascends and passes through the transverse foramen (TF) of the C6-C1 vertebrae. Atherosclerosis of the VA and degenerative changes in the cervical spine are likely to occur with aging, and subsequent morphologic changes may alter the normal anatomy. PURPOSE The aim was to determine the morphologic changes of TF and VA in relation to aging. STUDY DESIGN/SETTING This was a retrospective cross-sectional study. PATIENT SAMPLE One hundred ten consecutive patients who had undergone computed tomography angiography were included. METHODS The subjects were then divided into three groups according to age: Group A, less than 45 years; Group B, from 45 to 65 years; and Group C, older than 65 years. Cases with stenosis and dissection of the VA were excluded from the quantitative analysis. The areas of the VA and TF were measured, and the VA/TF occupation ratio (OR) was calculated accordingly. The presence of VAs tortuosity within the TF was also noted. RESULTS The TF was larger in the oldest group, but the difference was not statistically significant. There was also no significant statistical difference among the age groups in terms of the VA and VA/TF ORs (p>.05). In the Group C, the rate of overall tortuosity of the VA was 73%, and arterial tortuosity in the TF was 28.6%. In cases with tortuous VA, C6 and C4 TFs were found to be significantly larger. CONCLUSIONS Tortuous VAs tend to be associated with enlargement of C6 and C4 TFs. Knowledge of such changes in the anatomy is crucial during instrumentation used for cervical spine surgeries, to prevent serious complications in patients aged older than 65 years.

Utility of semiquantitative parameters to differentiate benign and malignant focal hepatic lesions.

OBJECTIVE Any distinction and the usefulness of semiquantitative parameters derived from dynamic-contrast-enhanced (DCE) MRI obtained with extracellular gadolinium contrast agent in hemangiomas, hepatocellular carcinomas (HCC) and metastases of the liver was studied prospectively. METHODS Seventy-four focal liver lesions (consisted of 34 hemangiomas, 23 HCC, and 17 metastases) of the 37 patients underwent DCE-MRI (six phases). Functional coloured maps and subsequently semiquantitative parameters were obtained using the FuncTool. Maximum and average (avg) values of mean time to enhancement (MTE), positive enhancement integral (PEI), time to peak (TP), maximum slope of increase (MSI), maximum slope of decrease (MSD) values were measured by placing the region of interest. The diagnosis of HCC and metastases were proven histopathologically and/or clinically. RESULTS The mean values of the paremeters were: In hemangiomas, avgMTE: 271.2 ± 4.7; avgPEI: 840.3 ± 77.3; avgTP: 146.6 ± 13.1; avgMSI: 999.1 ± 108.4; avgMSD: 254.1 ± 30.4. In HCC, avgMTE: 246 ± 3.6; avgPEI: 424.9 ± 31.6; avgTP: 132.8 ± 9.5; avgMSI: 484.1 ± 36.5; avgMSD: 109.1 ± 13.3. In metastases, avgMTE: 248.1 ± 8.2, avgPEI: 453.9 ± 39.6; avgTP: 142.8 ± 13.9; avgMSI: 472.6 ± 50.4 and avg MSD: 200.1 ± 38.2. Both maximum and avg values of MTE, PEI, MSI, and MSD were significantly higher in hemangiomas (P<.05). The most significant difference was found in avgPEI with 82.1% sensitivity and 67.6% specificity when 570 cutoff value was considered. The values however were not significantly different among HCC and metastases (P>.05). CONCLUSIONS Semiquantitative DCE-MRI parameters provide useful, complementary, and quantitative information. This technique increases diagnostic value of extracellular gadolinium contrast agent to characterize focal liver lesions and may be useful for follow-up after local-regional therapies.

Polysplenia Syndrome Detected after Chest Symptoms in Two Adult Patients: Case Report and Review of Literature

Summary Background Polisplenia syndrome (PSS) is a rare subtype of heterotaxy syndrome and means ambiguous location of the major thoracic and abdominal organs with vascular anomalies and multiple spleens. We reported on the findings of computed tomography (CT) of PSS in adults, detected incidentally. Case Report Two woman underwent a CT examination of the thorax for different thoracic pathologies. There were common abnormalities such as hyparterial bronchi and absence of middle lobe fissure on CTscans suggesting heterotaxy syndrome. Therefore, the abdominal CTs were performed to detect the accompanying abdominal anomalies. Our two cases defined as PSS were diagnosed with multiple spleens in the normal location in the abdomen. The left-dominant liver and short pancreas with agenesis of the pancreatic tail and lateral part of the body were detected on CT scan. In the first case, the vascular abnormalities were as follows: variant entrance of the main portal vein into the liver and atypically located superior mesenteric vein (SMV) joining with the splenic vein to form the portal vein. In the second case, the preduodenal portal vein and hemiazygos continuation with interruption of the hepatic segment of the inferior vena cava (IVC) were the vascular anomalies. The bowels were malrotated in the second case. Conclusions Although such cases are usually admitted as abdominal emergency, our two cases were detected during examinations for thoracic and cardiac pathologies. The knowledge and awareness of PSS can be helpful to diagnose pathology and plan surgical procedures.

Right Liver Lobe Hypoplasia and Related Abnormalities.

Summary Background Hypoplasia and agenesis of the liver lobe is a rare abnormality. It is associated with biliary system abnormalities, high location of the right kidney, and right colon interposition. These patients are prone to gallstones, portal hypertension and possible surgical complications because of anatomical disturbance. Case Report Magnetic resonance imaging features of a rare case of hypoplasia of the right lobe of the liver in a sigmoid cancer patient are presented. Conclusions Hypoplasia of the right liver should not be confused with liver atrophy; indeed, associations with other coexistent abnormalities are also possible. Awareness and familiarity with these anomalies are necessary to avoid fatal surgical and interventional complications.

Diffusion-weighted magnetic resonance imaging in the assessment of choroid plexus aging:

Recent studies have pointed out dysfunction and histopathological changes of the choroid plexuses (CPs) with aging. This paper reviews apparent diffusion coefficient (ADC) values of the CPs for age-related changes. All the brain MR images of the patients between January 2013 and June 2014 in our Radiology Department were retrospectively investigated. Patients with major cranial abnormalities (brain tumors, hyperacute or acute ischemia, developmental anomalies, hemorrhage, hydrocephaly) were excluded. Diffusion-weighted images were obtained at the parameter values of b = 1000 s/mm2 in the axial plane. The transverse diameters of the lateral ventricles (LVs) and ADC values of both CPs were measured. Brain MRIs of 202 individuals, 97 men (48%), 105 women (52%), were studied. There were statistically significant positive correlations between the ADC values of CP and patient ages. (Right CP: r = 0.623; p < 0.05. Left CP: r = 0.654; p < 0.05). There were positive correlations between LV diameters and age (r = 0.624, p < 0.05 for the right LV; r = 0.621, p < 0.05 for the left LV). The ADC values of age groups significantly differed (p < 0.05); the ≥61-year-old group was significantly higher compared to younger individuals. There is a progressive increase of water diffusivity in the CPs during aging. ADC values should be considered as a neuroimaging quantitative biomarker in normal aging-dementia syndromes.

Long-term Changes in L5-S1 Disks Under the Fusion Region and the Effect of Sagittal Balance on Degeneration

Background:The aim of this study was to radiologically assess long-term degeneration in the L5-S1 disks under the fusion region and to research its association with clinical signs in patients with degeneration. Methods:This study evaluated 23 patients who underwent spinal fusion between January 1994 and July 2005. Degeneration in the L5-S1 disks was assessed radiologically over a long-term 10-year follow-up period, and those cases that showed degeneration were further assessed using the Japan Orthopedic Association score and visual analog scale (VAS). Results:Seven of the cases had mild osteophyte development according to radiographic findings. A statistically significant decrease was observed in the front and back disk heights between the preoperative and postoperative measurements (P=0.001 and 0.000). A statistically significant decrease was also observed in the anterior and posterior disk height between the preoperative and postoperative measurements (P=0.007 and 0.007). A significant difference was observed in disk degeneration and facet joint degeneration (P=0.000 and 0.000). On evaluation of radiologic assessments, degeneration was observed in 15 cases (65.3%). Clinical assessment of the cases revealed that 6 patients (26.0%) with radiologic degeneration had lumbar pain of varying degrees, 3 of whom also had pain that spread to the legs; 1 of these caused loss of sensation in the leg. Clinical assessment of pain levels using VAS scoring for all cases revealed an average preoperative score of 8.71, an average early postoperative VAS score of 2.14, and an average long-term follow-up score of 3.35. The recovery rate of the patients was found to be 37.5%, according to Japan Orthopedic Association scoring. The pain level of the patients decreased by almost 4-fold in the postoperative early period and 2.5-fold in the long term. Conclusions:Spinal fusion surgery is an effective treatment method in terms of its clinical results, despite the adjacent segment degeneration that may be identified radiologically in the long term.

Endotrakeal preoklusif lipom: Nadir bir trakeal tıkanıklık nedeni

Malign trakeobronsial sistem tumorlerinin aksine solunum yollari selim tumorleri nadir gorulen tumorlerdir. Bu yazimizda, uzun zamandir astim tedavisi almakta olan sigara icicisi bir hastayi sunuyoruz. Hasta acil servise son zamanlarda artan nefes darligi ve egzersizle erken yorulma sikayetleri ile basvurdu. Yapilan cok kesitli bilgisayarli tomografi ( CKBT) incelemesinde proksimal trakeada hava sutununda ileri derecede daralmaya neden olan, -93.6 Hounsfield Unit (HU) olculen endotrakeal lipom ile uyumlu homojen duzgun konturlu lezyon saptandi.

Interrelationship between liver hemodynamics and tumor metabolism in liver metastases: diagnostic value of Doppler perfusion index revisited.

It should be expected that the hepatic blood flow increase in the cases with liver metastasis. We aimed to find out if there is a correlation between Doppler parameters and hepatic metabolic activity in oncology patients. 35 patients with hepatic metastases who were identified by 18F-fluorodeoxyglucose positron emission tomography scan and assessed with Doppler ultrasound were included in this prospective study. Patients with hepatic disease, cardiac dysfunction, dehydration, history of alcoholism, intake of antihypertensive or vasoactive medication were excluded. Volume flow of the proper hepatic artery and the portal vein were measured in the hepatoduodenal ligament by Doppler sonography. Doppler perfusion index (the ratio of the hepatic artery flow to the total liver blood flow) and flow volumes of 31 age matched subjects were compared. Both flow of the proper hepatic artery and portal vein were found to be significantly higher in patients with liver metastasis. The mean Doppler perfusion index value was 0.2 ± 0.13 in hepatic metastases whereas 0.13 ± 0.05 in control group. Doppler perfusion index was significantly higher in liver metastases (p=0.008). A positive correlation was found between the maximum standardized uptake value of the liver and flow volume of the proper hepatic artery (r=0.774, p=0). Blood flow of the proper hepatic artery and Doppler perfusion index correlates with hepatic standardized uptake value. Flow measurements of the liver may become an important parameter for selecting patients for further positron emission tomography scan and following-up the response after systemic and local therapeutic procedures.

Gastrointestinal stromal tumor mimicking gynecological mass: A case report

► GISTs do not have a unique appearance on ultrasound examination. ► If a pelvic mass is detected, the possibility of a non-gynecological tumor like GISTs has to be considered.