Gulgun Yilmaz Ovali

CT study on morphometry of frontal sinus

The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 ± 13.34 (range 20–83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31–40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity. Clin. Anat. 21:287–293, 2008.

No pituitary gland volume change in medication-free depressed patients

Increased serum cortisol levels and a hyperactive hypothalamo-pituitary-adrenal (HPA) axis have been proposed to play an important role in the pathophysiology of Major Depressive Disorder (MDD). However, there are inconsistent results regarding pituitary gland volume (PGV), which is one of the key elements of the HPA axis evaluated by MRI in depressed patients. In this study, we analyzed the PGV of medication-free moderately depressed MDD patients (N=34) and age and sex matched healthy controls (N=39). PGV did not differ between MDD patients and healthy controls [mean volume+/-S.D.; 0.76+/-0.17 cm3 and 0.75+/-0.14 cm3; ANCOVA, F1,69=1.25 p>0.05; respectively]. Our results confirm that volumetric PGV changes are not crucial for depression pathophysiology among unmedicated, moderately depressed adults.

Inverted papilloma with new bone formation: report of three cases.

Background An inverted papilloma (IP) is a benign sinonasal tumor of ectodermal origin, which is locally aggressive and destructive, tends to recur if incompletely removed, and has significant malignant potential. On CT scan, the appearance of an IP is variable and nonspecific but most commonly it appears to have soft tissue density. The association of IPs and new bone formation is extremely rare; to the best of our knowledge, only one case has been reported in the literature to date. Methods We report three cases with existence of bony mass surrounded by polypoid soft tissue diagnosed as IP histopathologically. Results The nature, shape, and location of the bony mass were not in concordance with trapped bone, with tumoral calcifications, or with osteoma. Conclusion We propose that with regard to the three cases presented here, new bone formation may be associated with IP pathologically. We also believe that additional investigations are required to characterize the pathophysiological mechanisms involved in neoplasm-induced osteogenesis.

A case of mycetoma successfully treated with itraconazole and co‐trimoxazole

A 29‐year‐old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill‐defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomoris methenamine silver stain. As minimal regression was seen on MRI with 4 months’ itraconazole (200 mg day−1) treatment, co‐trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.

Radiologic features of lumbar spine in ochronosis in late stages

Ochronosis is a rare hereditary disorder of tyrosine metabolism. Severe degenerative arthritis and spondylosis occur in the later stages of this disease. Radiologic examinations may reveal changes considered almost pathognomonic for ochronosis. We present the radiologic features of the lumbar spine in two ochronotic patients who were diagnosed after radiologic examinations in the late stages of the disease.

Magnetic resonance imaging findings in a case of remitting seronegative symmetrical synovitis with pitting edema.

We describe a case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) in a 66-year-old man. This report discusses magnetic resonance imaging findings of RS3PE syndrome and the changes after steroid therapy.

Symptomatic Spinal Migration of Subarachnoid Hemorrhage due to Ruptured Intradural Vertebral Artery Aneurysm

A 55‐year‐old patient was admitted to the hospital with severe acute back pain. Thoracolumbar magnetic resonance (MR) imaging showed hemorrhage in subarachnoidal‐subdural space. On cranial MR imaging and MR angiography, an aneurysm was suspected in the V4 segment of the right vertebral artery. Angiography showed a fusiform dissecting aneurysm in the V4 segment of right vertebral artery. The final diagnosis was ruptured V4 segment aneurysm with subsequent symptomatic migration of hemorrhage into the spinal subarachnoidal‐subdural space. The patient was treated endovascularly by coil occlusion of both the aneurysm and vertebral artery. This rare cause and possible mechanisms for spinal migration of intracranial hemorrhage after aneurysmal rupture is discussed.

Sonographic-Guided Injection of Corticosteroid in the Treatment of Lateral Epicondylitis

Objective: In this study the advantage of ultrasonography [US] in diagnosis and therapy of lateral epicondylitis [LE] was investigated in patients with lateral elbow pain and clinically diagnosed as LE. Methods: Fifty-two patients with LE were examined using sonography. For the patients in whom normal US examination was found, a blind injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine was performed [Group 1]. The patients whose clinical diagnosis was confirmed with US received a sonographic-guided injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine [Group 2]. Outcome measurements were performed at baseline, two weeks, one month, and three months. Pain and functional status were assessed using a visual analog scale, physical functioning and bodily pain scales of the Medical Outcomes Study 36 Item Short-Form Health Survey, a patient-rated forearm evaluation questionnaire, and a patient-specific functional scale. Painless grip strength bilaterally was also measured. Results: Twenty-four [46.2 percent] patients had a normal-appearing common extensor origin on US. The group in which diagnosis of LE was confirmed on US and sonographic-guided corticosteroid injections improved significantly from the baseline to the third month follow up [P < 0.000] in both clinical assessment and physical examination findings. Conclusions: Our case series suggested that sonography of the common extensor origin can be used to confirm LE in patients with lateral elbow pain. Although sonographic-guided injections produced more clinical improvement, further studies are needed to determine effectiveness of sonographic-guided injections.

Chondroid chordoma of the thoracic spine: case report

Sir, Chordomas are slow-growing, locally destructive tumours derived from remnants of the notochord. They occur mostly along the axial skeleton. The thoracic region is the least common area of involvement within the spine. Chondroid chordoma is defined as a chordoma with prominent cartilaginous foci, an entity which has better prognosis than classical chordoma. To our knowledge this is the first published case of chondroid chordoma in the thoracic spine. Chondroid chordoma should be considered in differential diagnosis of classical chordoma and other thoracic tumours. A 50-year-old male presented with progressive hemiparesia developing within 1 month and was admitted to the neurosurgery department of the Celal Bayar University Hospital. There was no history of trauma and his laboratory findings were normal. On computed tomography (CT) an extradurally located soft tissue mass with granular calcifications and relative stenosis of the spinal canal were seen. Lytic multiple lesions were approximately 20610 mm in size on both sides in T7, T8, T9 vertebral corpuses. On T1 weighted magnetic resonance imaging (MRI) the soft tissue mass was of predominantly low signal intensity and was causing significant compression of the cord at the level of T8. It was 40 mm in dimension at the saggital plane. The mass showed marked enhancement after contrast administration (Fig. 1). The patient underwent surgical excision as T8 corpectomy and stabilisation, followed by radiotherapy. There was no sign of recurrence 14 months post-operatively. Macroscopically, the mass was an extramedullar, encapsulated, grey-white lobular and cystic neoplasm. Microscopically, it contained areas showing chords or nests of cells with partly vacuolated cytoplasm (physaliphorous cells) embedded in a myxoid matrix and extensive cartilage formation with degenerative calcification (Fig. 2). Immunohistochemically, neoplastic cells showed strong staining for S-100 protein, vimentin, epithelial membrane antigen (EMA), pancytokeratin (Fig. 3), cytokeratin (CK)7 and CK20. Cartilaginous areas were negative except for S100 protein and vimentin. The mass was diagnosed as chondroid chordoma with these findings. Chordomas are rare locally aggressive tumours which arise from the primitive notochord. They may develop at any point along the original notochordal tract and have a slow growth pattern. Patients usually present with symptoms related to compression of the involved neural structures or other organs. Chondroid chordoma is an uncommon variant and is defined as a chordoma with prominent cartilaginous foci. Chordomas most commonly arise in the sacro-coccygeal or spheno-occipital regions. Spinal chordomas arise more frequently in the cervical than

Unusual long bone and metacarpo-carpal abnormalities in a case of pseudo-pseudohypoparathyroidism.

A case of pseudo-pseudohypoparathyroidism (PPH) with shortening of the left femur and tibia and coalition of the base of the fourth metacarpals with capitatum and hamatum in bilateral wrist joints was presented. Involvement of the fourth digits both in hands and feet were more prominent on the left side, with shortening of the left leg.