Emine Dagistan

Multiple tendon xanthomas in patient with heterozygous familial hypercholesterolaemia: sonographic and MRI findings

Tendon xanthomas are a component of familial hypercholesterolaemia, which is a hereditary disease and characterised by elevated low-density lipo protein cholesterol plasma levels and premature coronary artery disease. Tendon xanthomas are diagnostic for heterozygous familial hypercholesterolaemia (HFH) and they mostly occur in Achilles tendon. Sonography and MRI are superior to clinical assessment and are useful in detecting tendon xanthomas. In this report, we present ultrasonographic and MRI findings of multiple tendon xanthomas in a case of HFH.

The association of obesity and obesity-related conditions with carotid extra-medial thickness in children and adolescents.

Carotid extra‐medial thickness (EMT) and carotid intima‐media thickness (cIMT) provide information concerning vascular changes.

Efficacy of the greater occipital nerve block in recurrent migraine type headaches.

AIMS We aimed to evaluate six months of results following repeated GON blocks. METHODS We evaluated the results from GON block performed on 60 patients. Briefly, we applied a standard 2 mL of 0.5% Bupivacaine GON blockage once a week for 4 weeks. We recorded the Visual Analog Scale (VAS) scores, the number of migraine attacks and the Migraine Disability Assessment Questionnaire (MIDAS) scores. The study subjects were not allowed to use medication for prophylaxis, and Ibuprofen (400 mg, 1200 mg at maximum) was prescribed for any migraine attacks. RESULTS The initial mean number of attacks per month before starting treatment was 8.33+2.31. After treatment, the initial MIDAS mean was found to be 2.82 per month; this declined to 1.47 in 3rd, and was 1.50 in the 6th month. The individual month values were found to be significant, and were listed respectively as, 1st month: 3.95+2.52, 2nd month: 3.23+1.82, 3rd month: 2.60+1.90, 4th month: 2.68+2.10, 5th month: 2.58+1.90 and 6th month: 2.58+1.90. The mean VAS scores were recorded as follows for each month: 6.28±1.24, 3.13±0.97, 2.55±1.19, 2.35±1.26, 2.38±1.20 and 2.48±1.30, respectively. This difference was noted to be statistically significant. No difference regarding the efficacy of the treatment was determined when the results were compared across age groups. CONCLUSION We assume that GON blockage with 2 mL of 0.5% Bupivacaine can be a supportive treatment in migraine treatment, with no serious adverse effects reported.

Evaluation of simple blood counts as inflammation markers for brain tumor patients

AIMS Hemogram parameters in routine blood panels have been proposed as inflammation markers. These parameters, especially the red cell distribution width (RDW) and mean platelet volume (MPV), were evaluated as surrogate inflammatory markers in brain tumor patients. We aimed to observe RDW and MPV values of tumor patients and compare to those in healthy population. METHODS We recorded white blood cell count, neutrophil count, lymphocyte count, hemoglobin, hematocrit, RDW, platelet count, and MPV of the study group at the time of diagnosis and compared to those of the control subjects. RESULTS The RDW was significantly elevated in study group compared to that of the control subjects (p=0.001). The MPV was significantly lower in study group than that of the control group (p=0.01). CONCLUSION Decreased MPV and increased RDW were both associated with brain tumor. However, prospective studies with larger sample sizes are needed to support the results and expose MPV and RDW variations between metastatic and primary brain tumors.

Role of OHVIRA syndrome in renal agenesis: a case report

A 13-year-old female was admitted with abdominal pain and dysmenorrhea.Ultrasonography and magnetic resonance imaging revealed OHVIRA syndrome (uterusdidelphys, obstructed hemivagina, and ipsilateral renal agenesis). A left hysterectomy wasperformed. The patient recovered fully following treatment with vaginal septum resectionand drainage of a hematometrocolpos.

Ureteral quadruplication with three blind-ending branches

A case of left-sided ureteral quadruplication with 3 blind-ending branches detected in a 16-year-old boy was presented by its step by step diagnostic work-up and treatment plan which is the first published case in the literature.

CT and MRI findings of renal infestation by a huge active hydatid cyst

Hydatid cysts derived from a type of tapeworm called Echinococcus granulosis larvaes which can situate in various organs or tissues in human body. It encounters as an endemic zoonosis in many regions all over the world including eastern part of Turkey. Renal involvement of hydatid cysts is uncommon even in endemic areas. The imaging properties vary according to the phase of the disease. Although it is a benign condition, the diagnosis of a renal hydatid cyst is critical in managing treatment and complications, such as nephrectomy, medical treatment before surgery and the risk of anaphylaxis or dissemination during intervention. Herein authors reported a case of an isolated involvement of the right kidney by a huge active hydatid cyst in a young man who was treated surgically, emphasising its ultrasound, CT, contrast-enhanced MR and diffusion-weighted imaging findings.

Effect of Prone and Supine Positioning on Computed Tomography Urography Examination

Objectives: The aim of this study is to evaluate the effects of performing computed tomography (CT) urogram in the prone position in terms of diagnosis. Methods: CT urograms of 208 patients imaged randomly in the prone and supine positions were included in this study. A total of 199 patients and 370 collecting systems were examined in total. Axial raw data and reconstructed coronal thin and thick MIP images with a slice thickness of 5 mm were evaluated by 2 independent radiologists blinded to the initial diagnosis. Renal collecting system, ureters, and bladder were included in radiological evaluation. Anatomically, the renal collecting system was separated into 7 regions. Filling and dilatation of collecting systems were evaluated via images at urogram phase by scoring. Results: Filling in lower pole infundibulum (p = 0.006), distal ureter (p = 0.006); and highly dilated lower pole calyx (p = 0.020), pelvis (p = 0.006), and bladder (p < 0.001) were determined to be better in images in the prone position compared to the supine position. There were no statistical differences in other regions. Conclusion: Better contrast material filling is achieved in dilated or non-dilated lower pole collecting system, dilated renal pelvis, non-dilated distal ureter of kidney, and in the bladder only by imaging the urogram phase in the prone position compared to the supine position. Additionally, presence of dilatation is a factor that could adversely affect filling. Studies in the future may investigate the contribution of prone positioning to CT urogram with larger series comparing it with other methods and modalities.

Griscelli Syndrome presented with status epilepticus and hemophagocytic lymphohistiocytosis.

A 12-month-old female infant was referred to our hospital with prolonged fever and status epilepticus. Her weight and height were below the 5th percentile for age. Physical examination revealed marked hypotonia, fever, pallor, partial albinism with silvery gray hair, and hepatosplenomegaly (Figure 1A). Laboratory investigations showed anemia, thrombocytopenia, hypofibrinogenemia, hyperferritinemia, and hemophagocytosis at bone marrow examination (Figure 1B). Lymphocyte subsets and serum immunoglobulin levels were normal. Hair examination showed irregularly scanty melanin pigments (Figure 1C). Electroencephalographic study revealed encephalopathic findings, including decreased background activity with continuous slow wave discharges. Brain magnetic resonance imaging showed diffuse cerebral involvement (Figure 2). RAB27A encoding gene C.149delG mutation was detected. We diagnosed Griscelli syndrome (GS) with

Unilateral renal cystic disease in a 15-year-old female: A left huge kidney associated with significant morbidity

Unilateral renal cystic disease (URCD) is a rare nonfamilial, nonprogressive disorder of one kidney and is not related with autosomal dominant polycystic kidney disease. The present case is a report of a 15-year-old female who had a huge multicystic mass involving the lower and middle part of the left kidney with normal minimal residual renal parenchyma at the upper pole. All the laboratory tests were within normal limits. The right kidney was entirely normal. Left nephrectomy was performed because of a significant morbidity. Here, the clinic, radiologic and pathologic findings are described and their differential diagnosis is discussed.