Fatih Gulsen

Follow-Up of Extracranial Vertebral Artery Stents with Doppler Sonography

OBJECTIVE The objective of our study was to determine the Doppler sonography findings suggestive of restenosis in the follow-up of patients treated by stent placement in the extracranial vertebral artery. CONCLUSION Follow-up of vertebral artery stents with Doppler sonography may be performed by direct insonation of the stent or by indirect measurements from the V2 segment (the part of the vertebral artery that courses within the intervertebral foramina). The V2 segment Doppler sonography measurements may guide future examinations and provide essential information regarding the proximally deployed stent.

The use of Onyx for embolization of peripheral vascular malformations in pediatric patients

PurposeThe management of congenital peripheral vascular malformations (VMs) can present a difficult therapeutic challenge. Endovascular transcatheter embolization of peripheral VMs is widely accepted as a first therapeutic option for many VMs. However, data describing the use of Onyx are limited in children with peripheral VMs. Our aim is to retrospectively evaluate the results of transcatheter arterial embolization with Onyx for peripheral VMs in children.Materials and methodsWe analyzed clinical and imaging records of 16 patients who underwent 25 embolization procedures by using Onyx for peripheral VMs. In eight cases, embolization procedures were performed once; in seven cases, twice; and in one case, thrice.ResultsEmbolization was technically complete in 4 patients and incomplete in 12 patients. Clinically, complete success was achieved in nine patients, and partial success was achieved in six patients. In one patient, reflux to the anterior and posterior tibial arteries caused peripheral ischemia, and the patient was referred to undergo plastic surgery. There were no complications in the other 15 patients.ConclusionWith future studies to better characterize the safety profile of this agent in peripheral vasculature, embolization with Onyx may become a valuable treatment option for peripheral VMs in pediatric patients.

Breast Cancer Metastasis Involving Pterygopalatine Fossa: A Cause of Trigeminal Neuralgia

We present a case of metastatic breast cancer to pterygopalatine fossa (PPF) with a severe trigeminal neuralgia located in the V2 division of the trigeminal nerve area, which was diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). In 2002, a 62-year-old woman had a 6-month history of lancinating pain and hyphestesia on the right side of the face. The type of pain of this patient is a severe characteristic trigeminal neuralgia that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the V2 branch of the trigeminal nerve is distributed. Carbamazepine and other medications did not provide pain relief. Therefore, she has undergone maxillary nerve blocks whenever the pain worsened. She was operated for breast cancer on the right side in 2000. There were no findings of recurrence at the original site during her followup period. One year after the operation, CT examination of the lungs revealed a mass on the upper lobe of the right lung. She had undergone surgery for this mass and pathology revealed breast cancer metastasis. Neurological examination disclosed hypesthesia on the V2 branch of the right trigeminal nerve without other neurological deficits. There were no other cranial nerve abnormalities. Neurological examination was otherwise normal. CT examination revealed bony lyses of posterior wall of the right maxillary sinus (Figure 1A). MRI showed an enhancing soft tissue mass within the right pterygopalatine fossa and posterior portion of the maxillary sinus. Preand postcontrast T1-weighted images showed a right-sided soft tissue mass obliterating the fatty tissue of PPF (Figure 1B). Tumoral involvement was not detected in

Mixed Hepatocellular Carcinoma and Hepatoblastoma: Cytohistopathologic Findings and Differential Diagnosis

Background: Hepatocellular carcinoma (HCC) accounts for approximately 80% of all the primary malignant tumors of the liver. Hepatoblastoma (HBL) is the most common primary malignant neoplasm of the liver in childhood, and extremely rare in adults. To the best of our knowledge, this is the first report of an adult case with cytopathologic description of a combined HCC and HBL, occurring in a noncirrhotic liver. Case: A 24-year-old male was admitted to the hospital with right-sided abdominal pain. Masses in the liver were detected radiologically. Fine-needle aspiration biopsy and core-needle biopsy revealed a malignant hepatocellular tumor with features of both HCC and HBL. Conclusion: In the present case among the distinct HCC cell groups, areas of smaller and more primitive cells consistent with embryonal type HBL and some other groups of cells with intermediate morphology were observed. These findings suggested the probable single stem cell origin of the tumor with differentiation to both cell groups rather than a combination of two different tumors. Therefore, the term ‘malignant hepatocellular tumor’ could also be considered to define this particular tumor. This case provides support to the previous reports in which HBL areas are described in HCC.

Detection of Bladder Cancer Recurrence with Real-Time Three-Dimensional Ultrasonography-Based Virtual Cystoscopy

This prospective study evaluated the accuracy of grey-scale two-dimensional (2D) ultrasonography and real-time three-dimensional (3D) ultrasonography-based virtual cystoscopy for detecting early recurrence of bladder cancer in previously treated patients (n = 40). Real-time 3D ultrasonography-based virtual cystoscopy images were compared with both 2D ultrasonography and interval conventional cystoscopy pathology results. Ultrasound examinations were performed before routine follow-up with conventional cystoscopy. Overall sensitivity for real-time 3D ultrasonography-based virtual cystoscopy was lower than for 2D ultrasonography, indicating it did not provide additional information. The results of combined (2D and 3D) ultrasonography and conventional cystoscopy differed significantly. Where lesions were detected with combined ultrasonography, the number of previous cystoscopies was lower and the tumour stage was significantly higher at initial diagnosis, compared with cases where no lesions were detected. The results suggest that ultrasonography before cystoscopy can be performed more frequently - or, if no lesions are detected by ultrasonography, the interval between cystoscopies can be prolonged - in patients at high risk of bladder cancer recurrence.

Cross-sectional area of the labrum: role in the diagnosis of anterior acetabular labral tears

AbstractObjectiveTo investigate the utility of ultrasound cross-sectional area (CSA) measurements for diagnosing acetabular labral (AL) tears.MethodsThe study included qualitative/quantitative ultrasound examinations of 55 hips in 52 patients with a presumed diagnosis of AL tear and 56 hips in 28 healthy volunteers. MR arthrography examinations were available only for the patients and were reviewed for the presence of AL thickening and tear.ResultsThe CSA of the anterior labrum was significantly larger in patients with an AL tear on MR arthrography than those in healthy volunteers (P < 0.01). The CSA cut-off value in determining labral thickening that maximises accuracy was 34.7 mm2, and sensitivity, specificity and accuracy were 86.7%, 74.1% and 77.5%. Direct signs of AL tear on ultrasound had sensitivity, specificity and accuracy of 34.9%, 91.7% and 47.3%. The CSA cut-off value that maximises the accuracy of the AL tear was 40.6 mm2, and sensitivity, specificity and accuracy were 58.1%, 91.2% and 78.4%.ConclusionsUltrasound detects the thickened labrum frequently observed in MR arthrography studies, especially in patients with dysplastic hips. Although specificity of the method of detecting AL tears is high, sensitivity is low, with an overlap between subjects with AL tear and controls.Key Points• Labral degeneration is frequent in dysplastic hips • Thickened labra are frequently observed on MR arthrograms • Labral thickening can be depicted by quantitative ultrasound measurements • The sensitivity is low with overlap between subjects with AL tear and controls

Endovascular stent-graft placement for ruptured dissecting aortic aneurysm in an adolescent patient with systemic lupus erythematosus: case report

Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disease with multi-organ involvement that is associated with the presence of autoantibodies, and it is influenced by genetic, endocrine, or environmental backgrounds such as exposure to ultraviolet rays and viral infections for the etiopathogenesis [1]. In the cardiovascular system, it frequently causes pericarditis, nonbacterial verrucous endocarditis, coronary artery disease, and cardiomyopathy [2]. Cardiovascular complications in SLE are generally presumed to be associated with inflammatory activity as well as premature development of atherosclerosis [1]. The overall morbidity and death from these complications have been increasing in recent years, and they are now the major cause of death in SLE [3]. Dissecting aortic aneurysm in SLE has been recognized as a rare life-threatening complication, but its pathogenesis is still obscure. The pathogenesis of aortic aneurysms and dissection in SLE has been attributed to aortic circulatory disturbances resulting from vasculitis and cystic medial degeneration as well as to atherosclerosis. The occurrence of atherosclerosis is considered to be due to long-term steroid treatment, hyperlipidemia, hypertension, and nephrotic syndrome [4]. The importance of the high prevalence of premature atherosclerosis and cardiovascular disease in SLE should be addressed, even in young adolescents, and especially those with early childhood-onset disease. Nevertheless, aortic dissection is a life-threatening disorder that requires immediate diagnosis and treatment to prevent mortality. To our knowledge, this is the second adolescent patient with childhood-onset SLE complicated with aortic dissection, but the first case treated with endovascular stent-grafting.

Intrathecal gadolinium-enhanced MR-cisternography in spontaneous intracranial hypotension associated with Behcet's syndrome.

We report a 32‐year‐old woman diagnosed with spontaneous intracranial hypotension (SIH) and Behcets Syndrome. Suspicion of SIH was based on cervical MRI findings, and magnetic resonanace (MR)‐cisternography revealed dural leaks bilaterally at lumbar region. MR‐cisternography is a recently performed technique and gaining importance in demonstration of CSF fistula.

Testicular volume before and after hydrocelectomy in children

Objective. The purpose of this study was to investigate whether there is an association between communicating congenital hydroceles and testicular volume in children. Methods. Seventeen children with unilateral communicating congenital hydroceles who underwent hydrocelectomies were included in the study. Testicular volumes were measured before and after hydrocelectomy on both the affected and unaffected sides. Results. We found statistically significant differences in testicular volumes between the normal sides (mean ± SD, 0.62 ± 0.24 mL) and the sides with hydroceles (0.72 ± 0.26 mL) before surgery (P < .001) and in testicular volumes of the sides with hydroceles before (0.72 ± 0.26 mL) and after (0.60 ± 0.19 mL) surgery (P < .001). There was no significant difference in testicular volumes before (0.62 ± 0.24 mL) and after (0.62 ± 0.21) surgery on the normal sides (P = .978). The mean decrease in volume of the testes with hydroceles after hydrocelectomy was approximately 15%. Conclusions. This study shows that there is an association between congenital communicating hydroceles and testicular volume in children. Clinicians should be aware that there is a decrease in testicular volume after hydrocelectomy so they do not misdiagnose this change as postoperative trauma or atrophy.

Testicular Arteriovenous Malformation: Gray-Scale and Color Doppler Ultrasonography Features

Intratesticular arteriovenous malformations (AVMs) are extremely rare benign incidental lesions of the testis. Ultrasonography (US) generally reveals a hypoechoic solid mass within the testicular parenchyma. We describe a patient with intratesticular AVM which was found incidentally during workup for infertility. The gray-scale and Doppler US appearance of an intratesticular AVM and the differential diagnosis have been presented. Based on the gray-scale, US appearance differentiation from malignant testicular tumors is difficult. Doppler US examination aids in the diagnosis by demonstrating the vascular nature of the tumor.