Bilge Öztoprak

The role of triangular vertebral canal shape in surgical management of patients with lumbar spinal stenosis: a cross-sectional study

AIM We assessed the role of triangular vertebral canal shape (VCS) in pain severity, pain-related findings, and postoperative satisfaction in patients with lumbar spinal stenosis (LSS) who had undergone decompressive surgery. MATERIAL AND METHODS This cross-sectional study conducted at a single center included 61 consecutive patients who had undergone surgical treatment for LSS. By comparing pre- and postoperative data, the role of triangular VCS in pain severity [assessed using a visual analog scale (VAS)], pain-related findings, and postoperative satisfaction of patients was examined. VCS was determined to be triangular, oval, or circular based on magnetic resonance imaging (MRI) and magnetic resonance myelography (MRM) findings. RESULTS Preoperative VAS scores of patients with triangular VCS were significantly higher than those of patients with oval and circular VCSs (P 0.05). No significant difference was found in postoperative VAS scores among patients with triangular, oval, and circular VCSs. In all subgroups, postoperative VAS scores were significantly lower than preoperative scores (P 0.05). This postoperative decrease in VAS scores was significantly higher among patients with triangular VCS than in those with oval or circular VCS (P 0.05). CONCLUSION Combined use of MRI and MRM can be recommended for symptomatic patients when planning surgery. Although pain severity decreased postoperatively in all patients, this decrease was more pronounced in patients with triangular VCS than in those with oval or circular VCS. During preoperative counseling of patients with LSS, the presence of triangular VCS should be considered. This may improve surgical outcome and patient satisfaction.

Is the brain spared in Crimean-Congo haemorrhagic fever? An MR-SWI study to reveal CNS involvement

ObjectivesThe aim of this prospective study is to investigate the central nervous system involvement in Crimean-Congo haemorrhagic fever (CCHF) with magnetic resonance imaging (MRI) in conjunction with clinical and laboratory findings.MethodsBetween July 2015 and August 2016, 36 patients with CCHF were undergone brain MRI including SWI. Two MRIs, one at the time of admission and the second in the convalescent period, were performed for each patient in order to see if there is any sign of central nervous system (CNS) involvement, especially in terms of intracranial haemorrhage or viral encephalitis. Clinical severity scoring was also done and laboratory findings were noted in order to correlate with clinical and imaging findings.ResultsNone of the 36 patients showed any MRI findings of an acute intracranial event during the course of the disease. There was a significant difference between mild cases and moderate cases in terms of some laboratory parameters (p < 0.05).ConclusionsAlthough CCHF is a highly lethal disease which involves multiple organs and systems, CNS involvement seems to be extremely rare in mild and moderate cases.Key Points• MRI is the imaging method of choice to diagnose microbleeds and encephalitis• Although CCHF causes multisystem bleeding, intracranial haemorrhage seems to be very rare• CNS complications are uncommon, even in the setting of suggestive symptoms• Death usually results from extracranial bleeding and multiorgan failure• Severity scoring is associated with some laboratory abnormalities in CCHF

Value of Multiple Computed Tomography Criteria for Prediction of Malignancy in Patients with Ovarian Mass

Objective: Computed tomography (CT) can be used as a safe, accurate and noninvasive technique for the prediction of ovarian malignancy with several criteria. We aimed to determine the sensitivity and specificity of presence of multiple CT malignancy criteria for the prediction of ovarian malignancy in patients with ovarian mass. Study Design: From a total of 734 patients diagnosed with an adnexal mass, ovarian mass was determined in 91 contrast-enhanced abdominopelvic CT images were examined for the presence of tumoral diameter (>50 mm), thick septa, wall thickness, solid component, contrast involvement, invasion, ascites, and bilaterality. The ratios of these parameters and the value of their combined use for the prediction of ovarian malignancy was assessed. Results: Of the 91 patients included in the study, in patients with benign [in 66 (72.5%) patients] and malign [(in 25 (27.5%) patients] ovarian mass, the mean (range) ages were 43.5 (17-82) and 58.0 (34-88) years, respectively. A statistically significant relationship was determined between ovarian malignancy and all the CT criteria (p 50 mm) and wall thickness (p>0.05). The ROC analysis revealed that with the presence of 3 or more criteria among the 8 CT criteria, the ovarian mass can be predicted as malignant at least with a sensitivity of 76% and specificity of 70%. Conclusion: The presence of 3 or more parameters among the 8 selected CT criteria, the ovarian malignancy can be predicted at least with a sensitivity of 76% and specificity of 70% in patients with ovarian mass.

Transvers küçük cilt kesisiyle karpal tünel serbestleştirilmesi

Amac: Karpal tunel sendromu cerrahisinde mini cilt insizyonu teknigi populerlesmektedir. Teknigin ana avantaji kisa iyilesme zamani ve daha iyi kozmetik sonuctur. Norovaskuler zedelenme ihtimali mini cilt insizyonu tekniginde hala tartisma konusudur. Makalemizde transvers mini cilt insizyonu teknigini karpal tunel sendromu cerrahisindeki avantaj ve dezavantajlari acisindan tartistik Yontem: 62 karpal tunel cerrahisi mini cilt insizyonu ile uygulandi. Hastalarin 52 si kadin 10 u erkek idi. Ortalama yas 62 (en kucuk 38 en buyuk 82) olarak izlendi. Bulgular: Takipte hastalarin bulgu ve sikayetlerinde belirgin iyilesme izlendi. Hastalarin hic birinde rekurrens veya norovaskuler yapilarda zedelenme izlenmedi. Sonuc: Mini cilt insizyonu teknigi etkili, basit ve cerrahi icin pahali ekipman gerektirmiyor. Cerrahi sonrasi iz ve iyilesme zamaninda konvansyonel yonteme nazaran daha iyi sonuclar veriyor.

Transverse Mini Skin Incision for Carpal Tunnel Release

1 Ministry of Health, Aksaray State Hospital, Department of Neurosurgery, Aksaray, Turkey 2 Cumhuriyet University Faculty of Medicine, Department of Neurosurgery, Sivas, Turkey 3 Cumhuriyet University Faculty of Medicine, Department of Radiology, Sivas, Turkey Corresponding author: Hüseyin Bozkurt, Cumhuriyet University Faculty of Medicine, Department of Neurosurgery, Sivas, Turkey E-mail: bozkurthuseyinn@gmail.com Received/Accepted: July 19, 2016 / March 23, 2017 Conflict of interest: There is not a conflict of interest.

Comparison of ultrasonography and dual echo magnetic resonance imaging in the diagnosis of fatty liver disease

Purpose: Fatty liver disease is a common cause of chronic liver disease affecting approximately one-third of the population. It is characterized by fatty infiltration of hepatocytes. It represents a spectrum of diseases including simple steatosis, steatohepatitis, fibrosis and cirrhosis. Ultrasonography, computerized tomography and magnetic resonance imaging can be used for the radiologic diagnosis of fatty liver. The aim of this study is to compare the diagnostic accuracy of Ultrasonography and dual echo magnetic resonance imaging in detecting fatty liver. Materials and methods:Magnetic resonance images and ultrasound reports obtained in the same 30 days of 112 patients out of 179 patients were evaluated retrospectively. Chemical shift-based dual echo in-phase and out-of-phase images were compared to sonographic findings for the presence of hepatic steatosis, the degree of steatosis and the extend of liver involvement. Signal intensity differences in inand out-of-phase images were calculated to quantify the fat fraction in the liver. Results: Out of 112 patients, 55 and 62 were diagnosed with fatty liver with ultrasound and magnetic resonance imaging, respectively. The difference between two radiologic techniques in detecting steatosis was not statistically significant (p=0.839). However, the difference between ultrasonography and magnetic resonance imaging with respect to the degree of liver steatosis and heterogenity of liver involvement were statistically significant (p=0.004 and p<0.001, respectively). doi: 10.5505/ptd.2016.68926

A DWI study of the contralateral hemisphere in cerebral hemiatrophy

BACKGROUND AND AIM Cerebral hemiatrophy (CHA) is a congenital or acquired loss of volume in one hemisphere of the brain. The MR findings of the affected hemisphere have been a subject of many studies, however, the contralateral hemisphere has not been investigated. There is, in fact, an integrity between two hemispheres of the brain through transverse connection fibers. The aim of this study is to investigate the changes in the contralateral hemisphere in CHA. MATERIALS AND METHODS Apparent diffusion coefficient (ADC) values were measured in deep gray and white matter areas in the normal-appearing contralateral hemisphere in 23 patients with CHA, in order to get in vivo information about a possible Wallerian degeneration or microstructural changes. Results were compared with the control group. RESULTS Normal ADC values were encountered in the contralateral hemisphere in all (100%) CHA patients. The difference between the ADC values of gray and white matter in CHA patients and the control group was not statistically significant. CONCLUSION Normal ADC values in the contralateral hemisphere in CHA patients suggests a compensatory mechanism restricting Wallerian degeneration or diffusion alteration.

Sonographic evaluation of jugulodigastric and juguloomohyoid lymph nodes.

The jugulodigastric (JD) and juguloomohyoid (JO) lymph nodes are levels II and III cervical lymph nodes corresponding to the upper and middle internal jugular chains, respectively. The aim of this study is to delineate the sonographic properties of these two nodes, which are commonly encountered in routine neck sonography, in subjects with normal neck ultrasound findings. Atypical findings can make it difficult to differentiate benign from malignant lymph nodes. The JD and JO lymph nodes of 126 subjects were examined by ultrasonography, and size, shape, presence of echogenic hilus and Doppler activity were recorded. Among the lymph nodes examined, 31.6% were not elliptical. Proportionally more of the JO than the JD nodes were round; there was a significant difference in roundness index between them (P < 0.05). An echogenic hilus was demonstrated in 223 of the 252 JD nodes and in 161 of the 252 JO nodes. Significantly more of the lymph nodes with roundness index <2 lacked a visible echogenic hilus. There was a positive correlation between the visibility of an echogenic hilus and Doppler activity. Normal jugulodigastric and juguloomohyoid lymph nodes are relatively prominent in the upper and middle jugular chains, respectively. Awareness of variations in the sonographic appearance of these nodes could preclude unnecessary procedures. Clin. Anat. 29:943–948, 2016.

The relationship of patent foramen ovale location with severity of stroke: A new risk factor for paradoxical embolism

Objective: Patent foramen ovale (PFO) is a common developmental anomaly and is well associated with paradoxical embolism and cryptogenic stroke. The aim of this study was to investigate the relationship of PFO location with severity of cryptogenic stroke. Materials and methods: Fifty patients with cryptogenic stroke and echocardiographically proven PFO were classified according to the severity of stroke. In order to define the location of PFOs, an imaginary line dividing the length of interatrial septum vertically into two equal parts was drawn manually at axial plane on cardiac multidetector computed tomography. PFOs located at superior part of this imaginary line was defined as superiorly located PFO, while PFOs located at inferior part of this imaginary line was defined as inferiorly located PFO. Results: Fourteen patients (28%) revealed mild, 20 patients (40%) revealed moderate and 16 patients (32%) had severe stroke. Based on PFO location, there were 34 patients (68%) with superiorly (group 1), and 16 patients (32%) with inferiorly (group 2) located PFO. It was found that patients of group 1 had significantly higher frequency of moderate or severe stroke compared to those of group 2 (p < 0.005) Conclusion: In conclusion, the patients with superiorly located PFO had higher frequency of severe stroke compared to the patients with inferiorly located PFO. Since this is a preliminary study, clinical application and importance of this finding necessitates further large-scale interventional studies.

A rare cause of pleural effusion: ruptured primary pleural hydatid cyst

Hydatidosis is an endemic parasitic disease in Mediterranean countries, often caused by the dog tapeworm Echinococcus granulosus. The disease predominantly affects the liver (60–70%) and lungs (30%), and the surgical management is considered as the gold standard for treatment. Besides anaphylactic reactions, the most frequent complication of the hydatid disease is rupture into neighbouring structures, often affecting the bronchi, gastrointestinal tract and peritoneal/pleural cavities, according to its location. Primary pleural hydatidosis is an extremely rare entity and we present a ruptured pleural hydatid cyst with unusual location.