Bilge Cakir

Evaluation of Tumor Angiogenesis with Contrast-Enhanced Dynamic Magnetic Resonance Mammography

Abstract:  The goal of this research was to correlate dynamic magnetic resonance (MR) mammographic contrast enhancement and microvessel densities in breast masses. Forty‐six female patients with breast masses detected by mammography and/or ultrasonography were included in the study. MR contrast enhancements of the lesions were investigated dynamically using axial three‐dimensional fast low‐angle shot sequences. After excisional biopsy or mastectomy, immunohistochemical staining with factor VIII‐RA was performed, followed by microvessel density measurements. Contrast enhancement patterns in dynamic MR mammography were compared with microvessel density measurements using Students t‐test, Pearsons moment correlation coefficients, and one‐way analysis of variance (ANOVA). Malignant lesions exhibited three different enhancement patterns: 1) a peak enhancement within 120 seconds (early phase), followed by a decrease in the delayed phase (25 cases); 2) an increase in the early phase, followed by a plateau in the delayed phase (9 cases); and 3) an increase throughout the examination without any peak (5 cases). In benign lesions, signal intensity did not exhibited a peak in five cases, whereas in two cases enhancement was increased in the early phase and made a plateau in the delayed phase. A significant correlation was found between microvessel density and the percentage of maximal signal increase following paramagnetic contrast administration (r = 0.322, p < 0.05). Dynamic enhancement patterns and rates of maximal signal increase predict microvessel density in breast malignancies and may possibly be used as prognostic indicators.

Spontaneous spinal epidural hematoma after seizure: a case report.

A 14-year-old girl applied to our pediatric emergency department with loss of consciousness and a generalized tonic-clonic seizure. Her seizure was treated with midazolam (0.1 mg/kg, a total of 5 mg). The seizures ceased right after the midazolam injection. To exclude possible intracranial abnormality as a cause of the seizure, cranial computed tomography was performed, and she was hospitalized for further evaluation. Cranial computed tomography scan showed no signs of intracranial abnormality. Twenty minutes after the cessation of seizures, she regained consciousness. Two hours later, she noticed sensory loss in her lower limbs and progressive back pain. Neurologic evaluation revealed paresis of the upper limbs, diplegia of the lower limbs, and urinary retention. Her body temperature, pulse, respiration, and blood pressure were 36.2°C (97.2°F), 78 beats/min, 22 breaths/min, and 150/90 mm Hg, respectively. Cranial nerves were intact. Deep-tendon reflexes were hyperactive on both upper extremities and absent on both lower extremities, and there were no pathologic reflexes. She had no sensation below the level of T6. Other clinical findings were tenderness in the upper thoracic region and absence of sphincter tone. There were no other pathologic physical examination findings. The medical history was negative for anticoagulant therapy, vascular abnormality, trauma, and bleeding disorders. Initial investigations including a complete blood cell count, serum electrolytes, liver function tests, Introduction

Primary angiosarcoma of the spleen: In vivo and in vitro MRI findings

Primary splenic angiosarcomas are extremely rare tumors with very poor prognosis. These tumors, highly aggressive and lethal, present with widespread metastatic disease or splenic ruptures. The possibility to lengthen the survival by splenectomy before the development of splenic rupture makes an early radiological diagnosis a necessity. Multimodality imaging findings of a patient with splenic angiosarcoma is presented. In vivo and in vitro magnetic resonance imaging (MRI) features of the spleen are compared to macro- and micropathological findings.

A non-alcoholic patient with acute Marchiafava-Bignami disease associated with gynecologic malignancy: paraneoplastic Marchiafava-Bignami disease?

We report a 45-year-old, non-alcoholic woman with ovarian cancer who presented with acute impairment of consciousness. Cranial MRI revealed symmetrical and bilateral increased signal intensities of the corpus callosum and the dentate nucleus, without contrast enhancement. The findings are comparable with Marchiafava-Bignami disease (MBD), although pathological confirmation was not possible. Most of the reported cases of MBD are related to chronic ingestion of red wine and/or related with a nutritional cause. We suggest that this patient may suffer a MBD possible related to the ovarian cancer.

Pulmonary alveolar proteinosis in a patient with acute lymphoid leukemia regression after G-CSF therapy.

Pulmonary alveolar proteinosis (PAP) is the intra-alveolar accumulation of periodic-acid schiff (PAS) positive material. PAP is one of the underrecognized causes of pulmonary infiltrates in patients with hematologic malignancies. Here, we present a patient with acute lymphoid leukemia (ALL) in first remission that developed fever and diffuse pulmonary infiltrates during the neutropenic stage of consolidation chemotherapy. The histopathologic examination of bronchoalveolar lavage (BAL) fluid and transbronchial biopsy specimen demonstrated the presence of PAS-positive eosinophilic material. Empirical antibiotherapy and granulocyte-colony stimulating factor (G-CSF) were given. After the correction of neutropenia with G-CSF, the patients fever disappeared, acute phase reactants decreased, pulmonary infiltrates resolved. We present this case because it was the first patient in whom the correction of neutropenia with G-CSF was followed by resolution of PAP.

Relationship Between Mastoid Pneumatization and Middle Ear Barotrauma in Divers

Objectives/Hypothesis Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (s elf‐c ontained u nderwater b reathing a pparatus) divers.

Staphylococcal pyomyositis in a patient with non-Hodgkin's lymphoma

Abstract Pyomyositis is a rare disease, encountered mainly in tropical climates. The diagnosis of this entity is difficult, if not misdiagnosed, because of its rarity and its subacute presentation. We report of a 42-year-old man, in whom pyomyositis developed while he was receiving the standard chemotherapy for T-cell non-Hodgkins lymphoma (NHL). Three months following splenectomy, multiple abscesses occurred in the muscles of both thighs while the patient was receiving the third course of the CHOP regimen. A purulent exudate was aspirated from the abscesses under computed tomographic guidance. Coagulase-positive Staphylococcus aureus was cultured in the aspirate. Pyomyositis was completely resolved following the surgical drainage and the antistaphylococcal antibiotic treatment. This patient has shown that immunosuppression due to splenectomy, NHL, and chemotherapy, especially when using steroids, could be risk factors for pyomyositis in nontropical or semitropical countries.

Acute Abdomen Caused by Brucellar Hepatic Abscess

Brucellosis is a zoonotic infection that is transmitted from animals to humans by ingestion of infected food products, direct contact with an infected animal, or aerosol inhalation. The disease is endemic in many countries, including the Mediterranean basin, the Middle East, India, Mexico, Central and South America and, central and southwest Asia. Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella infection. We present a case of hepatic abscess caused by Brucella, which resembled the clinical presentation of surgical acute abdomen.

Normal Magnetic Resonance Contrast Enhancement of Extraocular Muscles: A Quantitative Analysis

The purpose was to evaluate quantitatively the magnetic resonance contrast enhancement of normal extraocular muscles and the use of temporal muscles as a reference of enhancement. Eighty extraocular and 20 temporal muscles were taken into analysis. Before contrast administration, mean intensity of extraocular muscles was found to be higher than that of temporal muscles (p < 0.000). With contrast agent, all extraocular muscles were enhanced more (111% enhancement) than the temporal muscles (45% enhancement, p < 0.000). Lateral recti had the lowest signal intensity, both in pre- and postcontrast images (p < 0.005). Normal extraocular muscles showed prominent enhancement on contrast-enhanced T1-weighted images. Temporal muscles were also enhanced in all subjects, urging the observers to compare the enhancement of extraocular muscles not with the latter.

Seat belt injury of the breast: MR mammographic follow-up

Abstract Fat necrosis of the breast is a benign inflammatory process that most commonly occurs as the result of breast trauma. The radiographic and clinical significance of fat necrosis of the breast is that it may mimic a malignancy. We report mammographic, sonographic and MR imaging findings and evolution of the lesions located along the seat-belt line in a case of fat necrosis of the breast after a car accident.