Besir Erdogmus

The thickness of the ligamentum flavum in relation to age and gender.

Hypertrophy of the ligamentum flavum (LF) can reduce the diameter of the spinal canal posteriorly. Such stenosis may significantly compress the dural sac and nerve roots, resulting in symptoms, even without a bulging anulus fibrosus or herniated nucleus pulposus. We conducted an anatomical study to determine the influence of age and gender on the thickness of the LF at the lower lumbar levels using magnetic resonance imaging (MRI). The thickness of 1,280 ligaments was determined at the L4‐L5 and L5‐S1 levels from MRIs. We screened 320 patients (152 males [47.5%] and 168 females [52.5%]) between 21 and 82 years of age. There were no significant differences in LF thickness with respect to gender (P > 0.05). Age was not correlated with the thicknesses of the LF. The left LF at the L4‐L5 and L5‐S1 levels was significantly thicker than on the right side (P < 0.05). Furthermore, the LF thicknesses at L5‐S1 bilaterally were significantly greater than on the corresponding sides at L4‐L5 (P < 0.05). The LF is an important anatomical structure, which might cause low back or leg pain. Therefore, the thickness of the LF should be measured and evaluated carefully in the case of spinal stenosis. Clin. Anat. 23:79–83, 2010.

Doppler waveforms of the hepatic veins in children with diffuse fatty infiltration of the liver.

OBJECTIVE The aim of this study was to investigate the effect of fatty infiltration of the liver (FIL) on the Doppler waveform pattern in the hepatic veins of obese children. METHODS In this prospective study, 59 patients with diffuse FIL and 45 normal healthy children who served as control group underwent hepatic vein B-mod and duplex Doppler sonography. The Doppler sonography spectrum of the right hepatic vein was classified into three groups: triphasic waveform, biphasic waveform, and monophasic or flat waveform. RESULTS There was a statistically significant difference in the phasicity of hepatic venous flow between patients and control subjects (p<0.001). The Doppler flow pattern in the right hepatic vein was triphasic in 28 (47.5%), biphasic in 28 (47.5%), and monophasic in 3 (5%) children with fatty liver, while it was triphasic in 43 (95.6%) and biphasic in 2 (4.4%) control subjects. There was an inverse correlation between the sonographic grade of fatty infiltration of the liver and the phasicity of hepatic venous flow (r=-0.479, p<0.001). CONCLUSIONS Abnormal right hepatic vein Doppler waveform, biphasic as well as monophasic, can be seen in healthy obese children with diffuse FIL.

Investigation of the Effect of Exhaust Particles on Ocular Blood Flow in Highway Toll Collectors Using Color Doppler Ultrasonography

Purpose: To investigate the effect of exhaust particles on orbital blood flow velocity of the ophthalmic artery, central retinal artery, and posterior ciliary artery by color Doppler ultrasonography in highway toll collectors. Material and Methods: Color Doppler imaging was used to measure the peak-systolic and end-diastolic flow velocities and resistivity indices of the ophthalmic artery, central retinal artery, and posterior ciliary artery in 20 toll collectors and 20 controls. Results: Both the peak-systolic and the end-diastolic flow velocities were decreased in the ophthalmic artery, central retinal artery, and posterior ciliary artery, and the resistivity index was increased in the central retinal artery in toll collectors when compared with control groups. Results were considered statistically significant if P<0.05. Conclusion: It was determined that the effect of exhaust particles reduced ocular blood flow velocity in toll collectors as measured by color duplex Doppler ultrasonography.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis

Abstract Purpose: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. Methods: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV–EDV)/PSV]. Results: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. Conclusion: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Relationship between breast arterial calcifications detected on mammography and brachial artery intima-media thickness

SummaryPurposeAlthough breast arterial calcification (BAC) was shown to be related with coronary artery disease (CAD), hypertension (HT), diabetes mellitus (DM) and carotid intima-media thickness (C-IMT), but the association between BAC and brachial intima-media thickness (B-IMT) has not been evaluated yet. Our aim was to investigate whether associations existed between BAC and measure B-IMT and atherosclerosis (AS) by comparing these patients with healthy control subjects.MethodsA Total of 75 patients were included in the study. Subjects with or without BAC were assigned into one of two groups and those with a BAC were graded. Main brachial artery IMT was measured.ResultsWhen the effect of age was partialled out statistically, we found a statistically significant difference in mean B-IMT between BAC (+) (0.54 ± 0.09) and BAC (-) (0.45 ± 0.08) groups (p = 0.001) after the groups were adjusted for age.ConclusionsIn conclusion, even though the relationship between B-IMT and BAC was significant, like the relationship between C-IMT and BAC, significant age difference between BAC (+) and BAC (-) groups and no significant relationship between BAC and time after menopause, after adjustment for age, suggest a strong association between BAC and age rather than AS. This can be elucidated by pathological correlation studies in larger series of subjects.ZusammenfassungZiel der StudieObwohl gezeigt werden konnte, dass arterielle Kalzifikationen der Brust mit koronarer Herzkrankheit, Hypertonie, Diabetes mellitus und Carotid Intima-Media-Dicke korrelieren, wurde eine mögliche Beziehung zwischen Verkalkungen der Brust und der brachialen Intima-Media-Dicke bisher nicht untersucht. Ziel unserer Studie war es, zu untersuchen, ob eine solche Beziehung besteht, beziehungsweise ob eine Beziehung mit Atherosklerose vorliegt, wobei die Daten von Patienten und gesunden Kontrollpersonen verglichen wurden.MethodenInsgesamt wurden 75 Patienten in die Studie eingeschlossen. Patienten mit oder ohne arteriellen Verkalkungen in der Brust wurden einer von zwei Gruppen zugeteilt. Die Patienten mit einer Verkalkung wurden entsprechend dem Schweregrad graduiert. Die mittlere Intima-Media-Dicke der Brachialarterie wurde gemessen.ErgebnisseNach statistischer Ausschaltung des Einflusses vom Alter fanden wir einen statistisch signifikanten Unterschied in der mittleren Dicke der Intima-media der Arteria brachialis von Patienten mit arterieller Verkalkungen der Brust (+) (0,54 ± 0,09) im Vergleich zu jener von Patienten ohne diese Verkalkungen (-) (0,45 ± 0,08) (p = 0,001).SchlussfolgerungenUnsere Ergebnisse legen trotz der beobachteten signifikanten Korrelation zwischen der Intima-Media-Dicke der Arteria brachialis und den arteriellen Verkalkungen in der Brust eher eine Abhängigkeit der arteriellen Verkalkungen in der Brust vom Alter als von der Atherosklerose nahe. Diese Annahme beruht auf dem beobachteten signifikanten Altersunterschied zwischen den Patienten mit arteriellen Brustverkalkungen und jenen ohne, sowie der fehlenden Signifikanz einer Beziehung zwischen arteriellen Brustverkalkungen und der Zeit nach Beginn der Menopause nach Berücksichtigung des Alters.

Fusion defect in anterior arch of the atlas mimicking a fracture in a trauma patient.

A 22-year-old female patient was brought to the emergency department after a fall. No abnormal findings were found on her physical examination. Her cranial computed tomography scan was evaluated to be normal. An apparent hypodense line was detected on the anterior side of the first cervical vertebra (C1) (Figure). The lesion was suspected to be a fracture because the patient was brought to the emergency department owing to a trauma. Fortunately, there were no abnormal findings on her physical examination, and she did not state any trauma to the cervical region. Some sclerotic changes and digitation of the bony structures formed the hypodense line; midline location of the lesion, and the lack of soft-tissue lesions around that line made us to exclude the diagnosis of a fracture. Anterior arch cleft of the atlas was diagnosed, and the patient was advised for outpatient clinic follow-up.

Comment on “Is there a relationship between symptoms of patients and tomographic characteristics of styloid process?” (Okur et al. Surg Radiol Anat doi:10.1007/s00276-013-1213-2)

The length of normal styloid process is reported to have different measurements. Okur et al. [4] reported that mean length of styloid processes was 40.7 ± 10.8 mm on the right and 40.3 ± 10.9 mm on the left. Onbas et al. [5] reported that the length of the bony SP on both sides varied from 0 to 62 mm and mean length of styloid processes was 26.8 ± 10.0 mm. The different changes with related age have been reported in the styloid process [3]. ESP is present in approximately 4 % of the population. But, ESP is commonly asymptomatic. The treatment options of symptomatic cases are surgery, medical treatment such as benzodiazepines, steroids, and heat application has limited success [6]. In literature, the different variations of angulation, length, and morphology of the styloid process are described [4, 5]. So, diagnosis and imaging of ESP are important in the evaluation of treatment options. In the imaging of the ESP, CT scan with MIP and 3D reconstruction images those give detailed and reliable information about the styloid process are the preferred imaging techniques [4, 7]. Markedly ESP has been rarely reported in the literature like in our case and all enlarged styloid processes may not always be symptomatic [1]. So, ESP should always be taken into consideration in the cross-sectional imaging of the head and neck in asymptomatic cases. To the Editor,