Halit Reşit Gümele

VALUE OF RESISTIVE INDEX IN PATIENTS WITH CLINICAL DIABETIC NEPHROPATHY

OBJECTIVE To determine whether the intrarenal resistive index (RI) can be used as a predictor in patients with advanced clinical diabetic nephropathy. METHODS Sixty-eight kidneys belonging to 34 patients with type II diabetes mellitus and 100 kidneys of 50 healthy persons (control group) were evaluated with Doppler ultrasonography. RI values were obtained from intraparenchymal arteries, either the arcuate or interlobar arteries. Patients with diabetes were divided into two groups based on serum creatinine concentration: group 1 (n = 21 patients, 42 kidneys) had a serum creatinine concentration <1.4 mg/dL and group 2 (n = 13 patients, 26 kidneys) had a serum creatinine concentration >1.4 mg/dL. Regression analysis was used to examine the relations between intrarenal RI and age, serum creatinine concentration, and creatinine clearance rate. RESULTS The mean RI value (0.69+/-0.1) in patients with diabetes was significantly different from that of healthy subjects (0.56+/-023) (P < 0.00001). The RI value of the patients in group 2 (0.79+/-0.07) was significantly different from that of the patients in group 1 (0.61+/-0.04, P < 0.00001). Serum creatinine concentration and creatinine clearance rate showed high correlations (r = 0.84 and r = -0.76, respectively) with intrarenal RI values. CONCLUSIONS Because the intrarenal RI shows a high level of correlation with serum creatinine concentration and creatinine clearance rate, it can be used as a predictor in patients with advanced clinical diabetic nephropathy. Intrarenal RI does not offer any advantage over serum creatinine concentration and creatinine clearance rate in patients with early-stage diabetic nephropathy with normal renal function.

Effect of hypertension and candesartan on the blood flow velocity of the extraocular vessels in hypertensive patients

OBJECTIVE To define alterations in the blood flow velocities of the ophthalmic artery (OA), central retinal artery (CRA), posterior ciliary artery (PCA) in essential hypertension and to evaluate the effect of a new antihypertensive drug, candesartan which is an angiotensin II receptor antagonist, on the blood flow velocity in hypertensive patients. METHODS Blood flow velocity and resistive index (RI) of the OA, CRA, and PCA were measured in 22 hypertensive patients off medication and 15 controls by color Doppler imaging. After treatment with candesartan, blood flow velocity and RI were again measured in the hypertensive patients. RESULTS In controls (n=15), the OA had a mean peak systolic flow velocity (PSFV) of 48.1+/-2.6 cm/s, mean end diastolic flow velocity (EDFV) of 16+/-1.0 cm/s, and RI of 0.65+/-0.01; the CRA had a PSFV of 20.8+/-0.4 cm/s, EDFV of 9.4+/-0.3 cm/s, and RI of 0.54+/-0.01; the PCA had a PSFV of 23.6+/-0.7 cm/s, EDFV of 11.2+/-0.3 cm/s, and RI of 0.52+/-0.01. There was a significant decrease in the PSFV and EDFV of the vessels in the medication free hypertensive patients when compared with controls (P<0.05). In the hypertensive patients off medication (n=22), the OA had a PSFV of 29.4+/-1.2 cm/s, EDFV of 10.4+/-0.5 cm/s, and RI of 0.71+/-0.01; the CRA had a PSFV of 15.1+/-0.6 cm/s, EDFV of 5.4+/-0.3 cm/s, and RI of 0.65+/-0.02; the PCA had a PSFV of 17.2+/-0.6 cm/s, EDFV of 6.7+/-0.3 cm/s, and RI of 0.61+/-0.01. RI measured in the OA, CRA, PCA were significantly increased in the hypertensive patients when compared with the controls (P<0.05). In hypertensive patients after medication (n=22), OA had a PSFV of 38.3+/-2.5 cm/s, EDFV of 12.3+/-0.7 cm/s, and RI of 0.68+/-0.01; CRA had a PSFV of 19.2+/-0.5 cm/s, EDFV of 7.8+/-0.3 cm/s, and RI of 0.59+/-0.01; PCA had a PSFV of 20.8+/-0.8 cm/s, EDFV of 9.2+/-0.4 cm/s, and RI of 0.56+/-0.01. There was a significant increase in the blood flow velocities of the OA, CRA, PCA (P<0.05) and significant decrease in the RI values in the treated hypertensive patients when compared with the controls (P<0.05). But blood flow velocities and RI values did not reach the control level. CONCLUSION The increase in the RI values and the decrease in the blood flow velocity of extraocular vessels in the hypertensive patients are thought to be caused by increased peripheral resistance in the vessels of the eye and orbit. Although, it increases blood flow velocity and decreases RI significantly, candesartan treatment in the hypertensive patients cannot increase blood flow velocity and decrease RI to the control level.

Mesenteric involvement in neurofibromatosis type 1: CT and MRI findings in two cases

We report computerized tomographic and magnetic resonance imaging findings of neurofibromatosis type 1 with mesenteric involvement in two patients. The first patient was a 13-year-old female with a panmesenteric plexiform neurofibroma with segmental involvement of the bowel wall; she had a 3-year history of abdominal pain. The second patient was a 60-year-old female who presented with malignant transformation of multiple mesenteric neurofibromas 4 months after primary operation.

Sclerosing haemangioma arising within extralobar pulmonary sequestration

Extralobar pulmonary sequestration is a rare anomaly of abnormal pulmonary tissue without any communication to the bronchial tree. Sclerosing haemangioma is a rare lung tumour, generally seen in middle-aged women. The combination of these two rare pathologies has not been previously reported. We describe the CT and CT angiographic findings of sclerosing haemangioma arising within an extralobar pulmonary sequestration in a 2-year-old girl.

MR imaging of renal vein occlusion in dogs.

RATIONALE AND OBJECTIVES MR findings of renal vein thrombosis are not consistent in the literature. Our goal was to evaluate MR findings of kidneys after renal vein occlusion in dogs. METHODS Surgical ligation of renal veins was performed in seven dogs. Of these, five dogs were examined with MRI before surgery, on the day of the renal vein ligation, and on the 1st, 4th, 8th, 15th, and 30th days. The other two dogs underwent nephrectomy on the 4th and 8th days for histopathologic correlation. RESULTS On T1-weighted images, corticomedullary differentiation was lost in all dogs by the 15th day. On T2-weighted images, the signal intensity of the renal cortex was significantly decreased beginning on the first day. The kidneys showed no medullary enhancement in the postcontrast period. The volume of the kidney began increasing at the time of renal vein ligation, started to decrease after the 4th day, and developed significant atrophy by the 30th day. CONCLUSIONS After renal vein ligation, the renal cortex appears hypointense on T2-weighted images, corticomedullary differentiation is lost within 2 weeks on T1-weighted images, and the kidney becomes atrophic by 1 month.

Unilateral agenesis of internal carotid artery with subarachnoid hemorrhage: Report of two cases

Internal carotid artery (ICA) is a rare anomaly of embryologic development. Digital subtraction angiography examination showed no visualization of the ICA on the right side in a 30-year-old male patient and on the left side in a 47-year-old female patient. Computed tomography (CT) revealed the absence of the corresponding bony carotid canal. Doppler examinations of the common carotid and external carotid arteries on the affected sides demonstrated high-resistance flow characteristics. Two cases of ICA agenesis with subarachnoid hemorrhage were presented and the literature is reviewed.

Multi‐Slice Computed Tomography Urography After Diuretic Injection in Children with Urinary Tract Dilatation

Purpose: To evaluate the potential use of multi‐slice computed tomography urography (MSCTU) after diuretic injection in children with urinary tract dilatation. Material and Methods: MSCTU was performed in 19 patients (11 boys, 8 girls, mean age 5.4 years) with suspicion of urinary tract obstruction and dilatation. Furosemide, 1 mg/kg, was injected 3 min before contrast material administration and followed by a bolus of 30 ml of physiologic saline solution immediately after application of contrast material. Excretory‐phase images were obtained through the abdomen and pelvis beginning 10 min after initiation of the injection of contrast material. Maximum intensity projection (MIP) and volume rendering (VR) images were post‐processed to obtain urographic views. Results: MSCTU revealed pathology in 16 of 19 patients, while 3 patients had normal findings. Ureteropelvic obstruction was found in 4 patients, obstructive megaureter in 8. Both ureteropelvic obstruction and obstructive megaureter were disclosed in 1 patient, partial ureteral duplication in 1 patient, and both complete ureteral duplication and ureterocele in 2 patients. In all patients, MIP and VR images could satisfactorily show the pathologies of the urinary tract. The estimated effective average doses of MSCTU were higher than IVU. Conclusion: Preliminary results of furosemide‐enhanced MSCTU demonstrated consistently dilated urinary tracts, obstruction levels, and underlying pathologies better than US and IVU.

Hyperintense posterior pituitary lobe in central diabetes insipidus

We report a young child with central diabetes insipidus in whom the posterior lobe of the pituitary gave the high signal on T1-weighted MRI not generally seen in this disease.

Multicentric Castleman's disease in a child with subpectoral involvement.

Castlemans disease is a benign lymphoproliferative disorder characterised by enlarged hyperplastic lymph nodes. It is rare in children and usually presents as localised disease. Subpectoral involvement has not been previously described in multicentric Castlemans disease in children. We present the CT, US and Doppler US findings of hyaline-vascular type multicentric Castlemans disease in a 5 year-old-boy with masses in the left subpectoral region and supraclavicular and axillary lymphadenopathy.

Epiphyseal hypertrophy of first metacarpal simulating pseudoarthrosis in Fanconi's anemia

A 16-year-old male was admitted with fatigue and pallor of two years duration. Physical examination showed bilateral hand abnormalities, microcephaly, microphthalmia, and pallor. In his family history, it is noted that his cousin had similar findings but the other family members were noted as normal. The blood smear and bone marrow aspiration biopsy showed pancytopenia. Based on these findings he was diagnosed as Fanconis anemia. Radiography of the hands showed double phalanges on the right thumb, absence of the left navicular bone, hypoplasia of the first left metacarpal bone, and hypertrophied proximal epyphysis of the first metacarpals with sclerotic borders that resembled a pseudoarthrosis particularly marked on the left side (Fig. l). Abdominal ultrasonography also revealed pelvic fused kidneys which was confirmed by excretory urography. manifestation. Presence of severe microphthalmia and microcephaly are also uncommon. Other associated skeletal anomalies of Fanconis anemia may include deformities of the hand, wrist and radial side of the forearm, dislocation of hip, Sprengel deformity, Klippel-Feil anomaly, and flat feet [3]. Absence or hypoplasia of the thumb, first metacarpal and carpal bones, delayed ossification of the carpal bones, supernumerary thumb, clinodactly, hypoplasia of the phalanges, and double distal phalanges are described [1, 2]. The double phalanges and aplasia of the navicular bone are noted in our patient. Al though abnormality of the first metacarpal has been pointed out in the spectrum of the skeletal manifestations of Fanconis anemia, this is generally emphasized as hypoplasia or aplasia. To our knowledge, overgrowth of the epiphyses of the first metacarpals that simulates pseudoarticulation has not been described previously.