Fatih Düzgün

A mass screening survey of cystic echinococcosis by ultrasonography, Western blotting, and ELISA among university students in Manisa, Turkey.

Cystic echinococcosis (CE) is one of the most important zoonotic diseases in a wide geographic area, including Turkey. In the present project, a total of 4275 students from Celal Bayar University, Manisa, Turkey, were screened by ultrasonography (US) and specific antibodies for CE were examined by Western blotting (WB) and ELISA in finger prick blood samples of 2034 of 4275 volunteered students. We aimed to report the apparent prevalence of CE based on different diagnostic procedures and to compare WB and ELISA with US in diagnosis of CE in a mass screening setting. Six new cases were diagnosed as CE by US during the survey. In addition to these cases, three students were also detected to have been previously operated and pathologically confirmed for hepatic CE. US revealed parenchymal changes in these cases in concordance with their operation history; so, the prevalence of CE by US was calculated as 0.21% (9/4275) (95%CI, 0.11-0.39%) among university students in Manisa. Bands were detected at 8, 28, 32, 38, 42, 47, 70 and 90kDa by WB and the cases were considered to be positive for CE when at least three of the bands were seen together. Apparent prevalence of CE by ELISA and WB were found to be 2.11% (43/2034) (95%CI, 1.57-2.83%) and 0.25% (5/2034) (95%CI, 0.10-0.57%), respectively. Of the six US positive cases, WB was positive in only one case with two cysts in the liver. All of four cases with liver involvement were positive by ELISA. The high prevalence of CE among university students in Manisa indicated that CE is a major health problem in this area of Turkey. Our results supported that WB is rather difficult and not feasible as a mass screening test and may not be effective for confirmation especially in asymptomatic cases. As a result, we recommend US to be used initially in mass screening surveys for CE followed by confirmation by ELISA for suspected cases. Further examination primarily by chest X-ray followed by computed tomography and/or magnetic resonance imaging, if needed, should be recommended for US negative, ELISA and WB positive individuals who may have non-abdominal cysts.

Idiopathic thoracic spinal epidural lipomatosis causing spinal cord compression.

A 31-year-old man was admitted to the Emergency Department with complaint of weakness in the lower limbs and a worsening of long-term back pain. The patient had no bowel or bladder problems. On magnetic resonance imaging (MRI), epidural lipomatosis was observed between the T4–T9 levels and was associated with considerable pressure applied to the spinal cord from the posterior aspect (Fig. 1). A multilevel laminectomy and excision of the epidural fatty tissue mass was performed. The patient’s weakness in both legs improved considerably postoperatively. A follow-up MRI obtained 12 months after surgery demonstrated that the cord compression had resolved (Fig. 2). Spinal epidural lipomatosis is an uncommon disease, and its underlying pathologic mechanism is unknown. Magnetic resonance imaging is the diagnostic modality of choice for this disease, and the usual treatment is immediate laminectomy with the removal of epidural fat [1].

Rare Case of the T1 Hyperintense Vertebral Malignant Melanoma Metastasis

On magnetic resonance imaging (MRI), T1 hyperintense vertebral bone lesions are almost benign. However, metastatic bone malignant melanoma can show high signal on T1 sequences due to melanin and hemmorhagic component. In this present case, we report T1 hyperintense lumbar bone metastasis in a metastatic melanoma patient. T1 hyperintense metastasis is a very rare condition with a few case reports in the literature so far.

Progressive spinal epidural hemangioma in pregnancy.

A 33-year-old woman who was into 35 weeks of pregnancy was admitted to emergency service with complaints of bilateral paresthesia and weakness at the lower limbs. In magnetic resonance imaging (MRI), a hemangioma-like massive lesion localized in the epidural region was observed between the T6 and T8 levels, which is associated with a considerable pressure on the spinal cord from the posterior aspect (Fig. 1). Following Cesarean section operation, spinal angiography and embolization interventions were applied to overcome a possible hemorrhage risk before neurosurgery operation. In spinal angiography, a hypervascular massive lesion at the T6–T7 and T7–T8 levels was found. Selective embolization procedure was performed via using polyvinyl alcohol particles and pushable coils (Fig. 2). After the embolization, bilateral laminectomy and excision of the epidural hemangioma mass were made. No postoperative serious bleeding was encountered, and the symptoms were relieved rapidly after the surgery. Vertebral hemangioma associated with pregnancy is a rarely seen condition, and its course is mainly related to the hormonal and hemodynamic changes which take place during the pregnancy period [1]. In these cases, preoperative embolization procedure is an important and effective method which can increase the success rate of general surgical outcome by decreasing the risk of hemorrhage.