Davut Tuney

Inguinoscrotal bladder herniation is CT a useful tool in diagnosis? (case report)

Urinary bladder herniation into the inguinal canal is a rare occurrence. The condition is often diagnosed during inguinal hernia surgery. We present a rare case of inguinoscrotal bladder herniation with its computed tomography findings.

Skin manifestations of rheumatoid arthritis: a study of 215 Turkish patients.

Objective  To investigate the frequency and clinicopathological features of skin involvement in rheumatoid arthritis (RA), to find out whether early and aggressive disease‐modifying treatment is changing the spectrum towards a milder disease pattern.

Fat necrosis mimicking liposarcoma in a patient with pelvic lipomatosis: CT findings

Pelvic lipomatosis is a rare condition characterized by an overgrowth of normal fat in the perirectal and perivesical spaces. The most important differential diagnosis is liposarcoma. We present a case of pelvic lipomatosis associated with a mass, which was diagnosed radiologically as a liposarcoma, but surgical biopsy result revealed fat necrosis.

Diagnosis of liver cirrhosis in children based on colour doppler ultrasonography with histopathological correlation

Background. Changes in hepatic architecture in cirrhosis and chronic active hepatitis affect liver vascular haemodynamics. Objective. To determine the criteria for the diagnosis of liver cirrhosis using Doppler US. Materials and methods. Twenty-two children with liver disease of unknown histology were prospectively examined and compared with eight normal children. Doppler US of portal vein velocity, arterio-portal velocity ratio, loss of reverse flow component in the hepatic vein and hepatic artery visualisation were examined prior to liver biopsy. Doppler results were compared with histological activity indices. Twelve patients had cirrhosis and ten had chronic active hepatitis. Results. The most sensitive method (83 %) for the assessment of cirrhosis was portal vein velocity less than 20 cm/sec. Arterio-portal velocity ratio (greater than 3) and hepatic artery visualisation were less sensitive (75 % and 33 % respectively) but specificity was 100 % for all three methods. When these three methods were evaluated together, sensitivity increased to 91 % and accuracy to 96 %. Loss of reverse flow component was less specific (77 %) but was sensitive (75 %). Conclusions. Portal vein velocity, arterio-portal vein ratio and hepatic artery visualisation together were reliable in diagnosis of cirrhosis in the paediatric age group.

Left-Sided Paraduodenal Hernia: Report of a Case

Paraduodenal hernias are rare congenital malformations consisting of incomplete rotation of the midgut, which may lead to intestinal obstruction or simply be detected as an incidental finding at autopsy or laparotomy. We report a case of left paraduodenal hernia diagnosed preoperatively by computed tomography and operated on in an emergency setting for signs of peritoneal irritation. A misdiagnosis had been made when the patient suffered his first attack 6 months earlier and he had been treated for familial Mediterranean fever. We reduced the small bowel loops from the left paraduodenal hernia sac with ligation and transection of the inferior mesenteric vessels. The patient was discharged from hospital on postoperative day 4 after an uneventful recovery.

Superior mesenteric artery blood flow in children with celiac disease

BACKGROUND Knowledge of splanchinic hemodynamics in celiac disease is scarce. The hemodynamic parameters of the superior mesenteric artery were evaluated by duplex Doppler ultrasonography in children with celiac disease to show whether histomorphologic changes in small bowel mucosa led to any alteration in splanchinic blood flow. METHODS The hemodynamic parameters of the superior mesenteric artery were evaluated by Doppler ultrasonography in 23 children with celiac disease. Ten patients were studied at the time of diagnosis. The remaining 13 children were studied after complete clinical and histologic recovery induced by gluten-free diet. Additionally, 9 patients out of 13 who were on a gluten-free diet for about 2 years were given gluten challenge, and superior mesenteric artery blood flow was measured after the challenge. The results were compared with those of healthy children. RESULTS Peak systolic velocity of the superior mesenteric artery was higher in untreated celiac patients than in healthy controls and treated celiac patients. Peak systolic velocity of the superior mesenteric artery in the treated group of children was close to that of control subjects, implying that successful treatment with gluten-free diet improves hemodynamic changes. The comparison of Doppler ultrasonographic measurements of the challenge group before and after the gluten challenge revealed that the peak systolic velocity, resistive index, and blood flow of the superior mesenteric artery were changed significantly. CONCLUSIONS The pathophysiologic events in small bowel mucosa during the active phase of celiac disease induce some hemodynamic changes that can be detected noninvasively by duplex Doppler ultrasonography.

Quantitative assessment of liver fibrosis by digital image analysis: Relationship to Ishak staging and elasticity by shear-wave elastography.

To analyze the relationship between fibrosis staged by Ishak stage and quantified by digital image analysis (DIA), and to reveal the optimum performance of shear‐wave elastography (SWE) using quantitative DIA measurements as a comparative histological standard.

Can MRI related patient anxiety be prevented

PURPOSE To evaluate the effectivity of a combined intervention of information and communication to reduce magnetic resonance imaging (MRI) anxiety using prolactin and cortisol as biochemical markers and State Trait Anxiety Inventory (STAI). MATERIALS AND METHODS This study is a randomized prospective research. Sample size was 33 patients. Fourteen patients were enrolled as study group, compared to 19 patients as control group. Blood samples were collected by venous sampling, and STAI was filled before and after scan. State anxiety inventory was used twice. Study group received a standard information about MRI scans and were communicated with 2 minute intervals via intercom; control group had no intervention. Blood samples were carried in ice to be centrifuged and stored as soon as they were taken to study prolactin and cortisol. Data were stored and analyzed by SPSS 17.0. P value for significance was accepted as 0.05. RESULTS Prolactin-pre, prolactin-post, cortisol-pre, cortisol-post, cortisol percent increase, Trait Anxiety Inventory (TAI), SAI (State Anxiety Inventory) pre-scan and post-scan levels were similar between demographic groups. Cortisol-pre levels were similar between study and control, however prolactin-pre levels were significantly higher in control group. Study group had 6% lower cortisol level post-scan, whereas control group had 18% increase. Study and control groups had similar Trait Anxiety and SAI-pre scores. SAI-post scores were lower in study group when compared with control group. Study group also had lower SAI-post scores than SAI-pre, whereas control group had higher. CONCLUSION MRI anxiety can be reduced by information and communication. This combined method is shown to be effective and should be used during daily radiology routine.

Magnetic resonance enterography in refractory iron deficiency anemia: a pictorial overview.

AIM To highlight magnetic resonance enterography (MRE) for diagnosis of patients with refractory iron deficiency anemia and normal endoscopy results. METHODS Fifty-three patients diagnosed with iron deficiency anemia refractory to treatment and normal gastroscopy and colonoscopy results were admitted to this prospective study between June 2013 and December 2013. All patients underwent a standardized MRE examination with a 1.5 Tesla magnetic resonance imaging system using two six-channel phased-array abdominal coils. Adequate bowel distention and fast imaging sequences were utilized to achieve diagnostic accuracy. All segments of the small bowel, duodenum, jejunum, and ileum were examined in detail. All cases were examined independently by two radiologists with > 5 years of experience in abdominal magnetic resonance imaging. A consensus reading was performed for each patient following image examination. Both radiologists were blinded to patient history, laboratory findings, and endoscopy results. RESULTS Twenty (37.7%) male and 33 (62.3%) female patients were included in the study. The mean age of the patients was 52.2 ± 13.6 years (range: 19-81 years, median 51.0). The age difference between the male and female patient groups was not statistically significant (54.8 ± 16.3 years vs 50.7 ± 11.7 years). MRE results were normal for 49 patients (92.5%). Four patients had abnormal MRE results. One patient with antral thickening was diagnosed with antral gastritis in the second-look gastroscopy. One patient had focal wall thickening in the 3(rd) and 4(th) portions of the duodenum. The affected areas were biopsied in a subsequent duodenoscopy, and adenocarcinoma was diagnosed. One patient had a fistula and focal contrast enhancement in the distal ileal segments, consistent with Crohns disease. One patient had focal wall thickening with luminal narrowing in the mid-jejunum that was later biopsied during a double-balloon enteroscopy, and lymphoma was diagnosed. CONCLUSION MRE is a non-invasive and effective alternative for evaluating possible malignancies of the small intestines and can serve as a guide for a second-look endoscopy.

Should we consider topical silver nitrate irrigation as a definitive nonsurgical treatment for perianal fistula

BACKGROUND: Surgery is currently the sole treatment modality for anal fistulas. However, surgery is associated with complications such as permanent incontinence, which reduces quality of life. OBJECTIVE: To determine the rate of complete clinical healing of anal fistulas after irrigation of the fistula tract with silver nitrate solution as a nonsurgical treatment. DESIGN: Prospective single arm study. SETTING: Tertiary university hospital PATIENTS: Adult patients with symptomatic perianal fistula presenting between June 2012 and January 2013. INTERVENTION: Irrigation of the fistula tract with 1% silver nitrate solution. Irrigation was repeated every 2 weeks when necessary. MAIN OUTCOME MEASURES: The primary outcome measure was the rate of complete clinical healing. RESULTS: Fifty-six consecutive patients with anal fistula were analyzed. Of those, 29 (52%) had complete clinical healing without recurrence for a median of 10 months. The median number of irrigations needed for complete clinical healing was 4 (1–10). The level of satisfaction was excellent in patients with complete clinical healing. The frequency of complaints was the only independent factor that had an impact on healing; patients with intermittent discharge had a significantly higher rate of complete clinical healing (67%) than those with continuous discharge (40%). There were no notable complications. LIMITATIONS: Short follow-up, small sample size, and no comparisons. CONCLUSION: This study demonstrates that the application of silver nitrate solution often produces a favorable outcome in the treatment of anal fistula. This method may be considered as a first-line treatment for the disease because it is simple, performed on an outpatient basis, minimally invasive, and lacks the complications encountered with current conventional surgical modalities.