Gökçen Çoban

Unusual cause of dizziness: occult temporal lobe encephalocele into transverse sinus.

Encephaloceles are rare manifestations, and occur most freuently in the occipital region. Temporal lobe encephaloceles are efined as pathological herniations of brain parenchyma through ura mater and bone, and they involve the middle cranial fossa r lateral temporal cranial vault. The majority of cases of tempoal encephalocele reported in the literature to date have presented ith complaints of epilepsy or ear disturbance (e.g., hearing loss, torrhea, otitis media with or without rhinorrhea, and recurrent eningitis) [1]. We present herein a rare case of lateral temporal encephaloele presenting with dizziness and imbalance. Interestingly, the ncephalocele sac was bulging into the left transverse sinus. The atient’s complaints were considered to be due to the impact of he encephalocele sac on the shape and flow hemodynamics of he transverse sinus, which is also another unusual aspect of the ase.

Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy

Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

Multimodal MR imaging findings of a congenital glioblastoma multiforme

Dear Editor: We wish to report a case of congenital glioblastoma multiforme which is a rare high-grade glial tumor, with diffusionweighted magnetic resonance images and MR spectroscopy. Published reports are mostly based on clinical, genetical, and pathological behavior of the tumor; reports of radiological appearance are relatively uncommon. The imaging in those reports most commonly involved antenatal diagnoses by ultrasound; we did not recognize any report of MRI with diffusion and spectroscopy so far. An 8-month-old female infant from North Iraq presenting with an enlarging head was admitted to our hospital. The parents stated that they were told that the head circumference was larger than normal limits at birth. No further investigation was made at that time. On her routine follow-up onthe second month,aheadCTwasperformedbecauseoftheenlargedhead which revealeda supratentorialmass.The parents didnot seek any treatment at that time. Six months later, the baby was seen at our hospital, with the complaint of increasing enlargement of the head circumference. On physical examination, the patient was fine, with normal reflexes and normal responses to the stimuli, except for the macrocephaly. An MRI of the brain revealed a huge mass in the right frontal and parietal lobes which contained multiple small and large cystic areas and solid components that were isointense to gray matter on both T1-weighted- (Fig. 1a) and T2-weighted images. The

Amiodarone Induced Epididymitis: A Case Report

Introduction: Amiodarone is an effective drug for life-threatening arrhythmias like recurrent ventricular fibrillation and atrial fibrillation. Amiodarone creates rarely genitourinary side effects are seen. These are epididymitis, testicular dysfunction and impotance. Amiodarone aggregates and triggers inflammation in the head of the epididym. Case report: We present the case of a patient who developed epididymitis after 17 months of amiodarone therapy, using a low dose (100 mg per day). Although cessation of medication or dose lowering was not performed, remission of the patient only by analgesics is a distinct case reported in urological literature. Conclusions: This case stresses the importance of considering an adverse effect of amiodarone treatment as a cause when making a differential diagnosis of epididymitis.

SUNCT syndrome findings accompanied by cavernous segment aneurysm

Headache has been a discomfort for all mankind since ancient imes. In 1988, the International Headache Society (IHS) develped a headache classification system to serve as a standard in the iagnosis of headache and for clinical usage [1]. According to this lassification, there are four main groups for primary headaches nd 13 sub-groups for secondary headaches. Short-lasting Unilatral volatile Neuralgiform headache with Conjunctival injection nd Tearing (SUNCT) is a rare group of volatile headache syndromes 2]. Clinical findings are unilateral medium density stabbing pain –200 times daily in the orbital, periorbital and/or temporal areas. atients are mostly male, with a male/female ratio of 4.25, and the ean age is 50.7 years [2]. In the medical literature, secondary UNCT syndrome cases are divided into two groups as posterior ossa and pituitary abnormalities. The case reports representing the UNCT syndrome group secondary to a posterior fossa abnormality ave included homolateral cerebellopontine angle arteriovenous alformations; a brainstem cavernous hemangioma; a posteior fossa lesion in a human immunodeficiency virus/acquired mmunodeficiency syndrome (HIV/AIDS) patient; severe basilar mpression causing pontomedullary compression in a patient with steogenesis imperfecta; craniosynostosis resulting in a foreshortned posterior fossa; and ischemic brainstem infarction. Cases of UNCT syndrome secondary to pituitary adenomas, intracranial

Predisposing factors in posterior circulation infarcts: a vascular morphological assessment

IntroductionThe aim of the study is to assess the effect of shape, diameter, elongation and deviation criteria of basilar artery (BA), convergence angle and diameter variations of vertebral arteries, and concurrent chronic diseases on posterior circulation infarcts.MethodsBetween January 2010 and May 2013, 186 patients who underwent brain and diffusion magnetic resonance imaging (MRI) with suspected cerebrovascular accident and were diagnosed with posterior circulation infarct and 120 infarct negative control subjects were included in this case-control retrospective study. Vertebral artery (VA) and BA diameter, right (R) and left (L) VA angles at the level of bifurcation, and BA elongation-deviation, and shape of BA were assessed in a total of 306 subjects. Ischemic lesions in the posterior circulation were classified according to their anatomical location and vascular perfusion areas.ResultsNo significant difference was noted between the control and patient groups with respect to BA diameter (p = 0.676). The most effective risk factors for posterior circulation infarcts were as follows: BA elongation of 2 or 3, BA transverse location of 2 or 3, increase in left VA angle, and history of hypertension, hypercholesterolemia, and diabetes mellitus.ConclusionOur results suggest that prominent elongation and deviation, C and J shape of BA, and increased L VA angle may be the predictors of at-risk patients in posterior circulation infarcts. Reporting marked morphological BA and VA variations detected at routine brain MRI will aid in selection of patients. Timely detection and treatment of at-risk patients may be life-saving.

Body Mass Index, Cholecystitis, Cholelithiasis, Pancreatitis and Imaging of Common Bile Duct Stones

Purpose:Studies to date have not investigated whether body mass index (BMI) affects the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP). The purpose of this study was to investigate the effect of BMI and also concomitant pancreatitis, cholecystitis and cholelithiasis on the sensitivity and specificity of MRCP. Materials and Methods:Between January 2004 and December 2011, 185 patients were included in the study and divided into 3 groups according to BMI as normal, overweight or obese. Both MRCP and endoscopic retrograde cholangiopancreatography (ERCP) were performed in all patients. ERCP was accepted as the “gold standard.” The accuracy, sensitivity and specificity values of the 3 groups were calculated to determine any effects on the results of the MRCP. Results:Before separating into groups according to BMI, the statistical results for MRCP in the detection of stone disease were as follows: specificity 74.3%, sensitivity 81.7% and accuracy 79%. After dividing the patients into 3 groups according to BMI, the specificity of stone detection with MRCP in the normal-weight group was 93.8% but decreased to 65.5% in the overweight group and to 72% in the obese group. The sensitivity of stone detection with MRCP in the normal-weight group was 85.2% but decreased to 75% in the overweight group and increased to 88.9% in the obese group. The accuracy was 88.3% in the normal-weight group but decreased to 71.6% in the overweight group and to 81.9% in the obese group. Conclusion:Our study showed that MRCP performance was decreased in the overweight and obese groups.

Effect of Topical Tetracycline on Seroma Formation in the Lichtenstein Technique: A Prospective Randomized Study

We sought to investigate whether application of topical tetracycline has a limiting effect on seroma formation in patients undergoing hernia repair using a polypropylene mesh. This study was conducted in 96 patients undergoing an elective groin hernia repair. Patients were randomized and divided into 2 groups. After the graft was placed, and before external oblique muscle aponeurosis was closed, 5 mL tetracycline was administered on the graft in the tetracycline group (tetra group, n = 50), and 5 mL isotonic saline was administered in the control group (n = 46) without putting in a drain. Seroma checks via surface ultrasonography were done. Seroma amounts measured on the first day were significantly higher in the tetra group (P = 0.04). There were no significant differences regarding seroma measurements on the seventh day or in the first and second months. Topical tetracycline application has no limiting effect on seroma formation after a groin hernia operation.

An unusual case of Candida infection producing a fungus ball in the left atrial cavity.

We report the case of a 75-year-old male patient who was treated in our clinic for septicemia and subacute infective endocarditis caused by toxigenic Candida albicans. Transthoracic echocardiography revealed the presence of a thrombus in the left atrial cavity, and the diagnosis was confirmed by computerized tomography. The patient was operated on urgently. Histological examination of the embolic material removed from the left atrium showed the presence of yeast and hyphal forms of Candida albicans through periodic acid-Shiff stain. The patient was readmitted to the hospital on postoperative day 15, because of reembolism, and died later on. Here we present our approach to the diagnosis and treatment of this rare condition.

The importance of craniovertebral and cervicomedullary angles in cervicogenic headache.

PURPOSE Many studies have indicated that cervicogenic headache may originate from the cervical structures innervated by the upper cervical spinal nerves. To date, no study has investigated whether narrowing of the craniovertebral angle (CVA) or cervicomedullary angle (CMA) affects the three upper cervical spinal nerves. The aim of this study was to investigate the effect of CVA and/or CMA narrowing on the occurrence of cervicogenic headache. MATERIALS AND METHODS Two hundred and five patients diagnosed with cervicogenic headache were included in the study. The pain scores of patients were determined using a visual analog scale. The nonheadache control group consisted of 40 volunteers. CVA and CMA values were measured on sagittal T2-weighted magnetic resonance imaging (MRI), on two occasions by two radiologists. Angle values and categorized pain scores were compared statistically between the groups. RESULTS Intraobserver and interobserver agreement was over 97% for all measurements. Pain scores increased with decreasing CVA and CMA values. Mean angle values were significantly different among the pain categories (P < 0.001). The pain score was negatively correlated with CMA (Spearman correlation coefficient, rs, -0.676; P < 0.001) and CVA values (rs, -0.725; P < 0.001). CONCLUSION CVA or CMA narrowing affects the occurrence of cervicogenic headache. There is an inverse relationship between the angle values and pain scores.