Hasan Cece

Impact of contrast enhanced MRI on lymphocyte DNA damage and serum visfatin level

OBJECTIVES Nephrogenic systemic fibrosis is a novel clinical entity encountered in subjects undergoing contrast enhanced magnetic resonance imaging (MRI). The aim of the present study is to evaluate the impact of contrast enhanced MRI exposure on lymphocyte DNA damage and serum levels of visfatin. DESIGN AND METHODS Twenty-eight subjects undergoing contrast enhanced hypophysial MRI with omniscan were included in the study. Blood samples were drawn before MRI, after non-contrast MRI and after contrast enhanced MRI from each subject. Lymphocyte DNA damage was analyzed by the alkaline comet assay, whereas serum visfatin level was assessed with enzyme immuno assay. RESULTS Both lymphocyte DNA damage and serum visfatin levels were statistically significantly increased in samples withdrawn after contrast enhanced MRI compared to samples withdrawn after non-contrast enhanced MRI and baseline samples (ANOVA p<0.001, for both). CONCLUSIONS Findings of the present study revealed that the contrast enhanced MRI is associated with increased lymphocyte DNA damage and increased serum visfatin level.

Polyorchidism: a three-case report and review of the literature

The presence of more than two testes confirmed by histology is called polyorchidism. Polyorchidism is an extremely rare congenital anomaly with a few more than 100 cases reported in the literature. The majority of reported cases are asymptomatic patients, others present with cryptorchidism, hydrocele, varicocele, epididymitis, infertility, testicular malignancy and testicular torsion. Over a 2‐year period, we encountered three patients who were found to have polyorchidism; two men presented with cryptorchidism and one with chronic scrotal pain. Physical examination of the first and the third patient revealed normal testes in the scrotal sac, the other scrotal sac was empty and small solid mass (atrophic left testes) was palpated in the inguinal canal. Ultrasonographic examination of the scrotum and inguinal region confirmed the findings of the physical examination. Ultrasonographic examination of the second patient revealed supernumerary testes within the scrotum. Orchiectomy was made on the first and third patients’ supernumerary testes and ipsilateral inguinal high ligation was applied for herniorrhaphy. A conservative approach was preferred for the second patient, maybe preserving a potentially functional supernumerary testis to improve the capacity for spermatogenesis. The risk of malignancy justifies the removal of an atrophic and ectopic testis in polyorchidism. However, it would appear safe to preserve a viable intrascrotal supernumerary testis found incidentally at surgery, provided that the patient is followed‐up in the long term.

The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis

This study aimed to evaluate the changes in spleen and liver diffusion-weighted magnetic resonance imaging (DWI) in chronic viral hepatitis patients. The study comprised 47 patients and 30 healthy volunteers. DWIs were obtained. Apparent Diffusion Coefficient (ADC) measurements were made by transferring the images to the workstation. The measurements of value b 1000 were made from a total of five points of the liver and three points of the spleen. Liver biopsy was performed on the 47 patients. The fibrosis stages of the patients were defined according to the METAVIR scoring system. Students t-test was used in the comparison of mean ages, liver and spleen ADC values between the patient and the control group. Kruskal-Wallis followed by Mann-Whitney U Test with Bonferroni adjustment was performed in the comparison of mean ADC values of the patients at different stages and the control group. A statistically significant difference was determined between the patient and control group in respect of liver and spleen mean ADC values (P<0.05). F3 group showed a significant difference compared to control and F1 and F4 group showed a significant difference compared to control, F1, F2 and F3 group in terms of the mean liver ADC value (P<0.01). F3 and F4 group showed a significant difference compared to control and F1 group in terms of the mean spleen ADC value (P<0.01). As a result we believe that the measurement of liver and spleen ADC values may be an indicator in the determination of the level of fibrosis.

Diffusion-Weighted MRI of the Testes in Patients With Varicocele: A Preliminary Study

OBJECTIVE This preliminary study aimed to evaluate changes in apparent diffusion coefficient (ADC) values of the testes in patients presenting with varicocele. SUBJECTS AND METHODS This cross-sectional study included 25 consecutively recruited patients with varicocele and 25 healthy control volunteers. The ADC values were measured in all participants. Kolmogorov-Smirnov tests were used to test the normality of the data distributions, and the data were expressed as arithmetic means and SDs. A one-way analysis of variance with a post hoc Bonferroni test was used to analyze normally distributed continuous data. Independent sample Student t tests were used to compare continuous variables between two groups. Furthermore, a Pearson correlation coefficient analysis was used to examine the association of venous diameters with mean ADC values in patients with varicocele. A two-sided p value < 0.05 was considered statistically significant. Sensitivities, specificities, and areas under the curve were calculated for the ADC values. RESULTS The ADC values associated with the ipsilateral testicular parenchyma of patients with varicocele were found to be lower than those of healthy volunteers. Moreover, the ADC values of the contralateral testicular parenchyma in patients with varicocele were also lower than those of healthy volunteers. The sensitivity and specificity of ADC values were 90% and 96%, respectively, for patients with varicocele and 89.5% and 96% for healthy volunteers. The mean ADC values were significantly negatively correlated with venous diameter. CONCLUSION The measurement of testicular ADC values may be used as a diagnostic indicator in the detection of testicular fibrosis.

Evaluation of the Future Atherosclerotic Heart Disease with Oxidative Stress and Carotid Artery Intima Media Thickness in Gestational Diabetes Mellitus

Background and objective. In this study our aim was to evaluate paraoxonase (PON1) activity and free sulfhydryl groups (–SH) as antioxidative parameters and lipid hydroperoxide (LOOH) as oxidative parameter in the serum of women with gestational diabetes mellitus (GDM) and determine their relation with the degree of subclinical atherosclerosis. Material and methods. Serum samples from 39 pregnant women complicated with GDM and 40 healthy pregnant women were collected for the analysis of oxidative markers. Common carotid artery intima media thickness (CIMT) was measured for both groups to assess future atherosclerotic heart disease risk. PON1 activity and –SH were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with a xylenol orange assay. Results. CIMT and LOOH levels were significantly higher (p = 0.01, p < 0.001, respectively) in GDM group compared to controls, whereas PON1 and –SH levels were significantly lower (p < 0.001 for both). CIMT values were significantly correlated with body mass index (BMI), 50 g oral glucose tolerance test (OGTT), and mean arterial blood pressure (MABP) (p = 0.003, p = 0.02, and p = 0.03, respectively). However, there was no correlation between CIMT and oxidative markers. Conclusions. Increased levels of LOOH and decreased levels of PON1 and –SH showed disturbance of antioxidative mechanisms in GDM. These changes were associated with increased BMI and MABP which may be relevant to GDM pathophysiology. Furthermore, increased CIMT values in GDM compared to healthy controls designate increased risk of future atherosclerotic heart disease.

Impact of COPD exacerbation on cerebral blood flow

We aimed to investigate the impact of chronic obstructive pulmonary disease (COPD) exacerbation on cerebral blood flow (CBF). In 21 COPD patients - in both exacerbation and stable phases -Doppler ultrasonographies of internal carotid artery (ICA) and vertebral artery (VA) were performed. There were significant differences in total, anterior and posterior CBF, ICA and VA flow volumes in exacerbated COPD compared to stable COPD. Total CBF was correlated with cross-sectional areas of left and right ICA, whereas independent predictor of total CBF was cross-sectional area of right ICA. Increased CBF might indicate cerebral autoregulation-mediated vasodilatation to overcome COPD exacerbation induced hypoxia.

A case series of 46 appendectomies during pregnancy

ZusammenfassungZIEL DER ARBEIT: Von den Patienten mit Appendizitis sind nur wenige schwanger. Bei Schwangeren ist die Diagnose und das Management einer akuten Appendizitis oft schwierig. Wir haben versucht, an Hand unserer Serie von schwangeren Patientinnen mit akuter Appendizitis diese Schwierigkeiten zu durchleuchten. STUDIEN DESIGN: Die vorliegende Studie umfasst 46 schwangere Patientinnen, die von 2006 – 2009 nach Diagnosestellung einer akuten Appendizitis in unserer Klinik operiert wurden. Folgende Daten wurden retrospektiv aus den Krankengeschichten erhoben: Alter, Zeit bis zur Diagnose, Leukozytenzahl, Schwangerschaftsalter, Schwangerschaftsanamnese, Morbidität, Mortalität und Ergebnisse der Pathologie. ERGEBNISSE: Das mittlere Alter der Patieninnen lag bei 26 Jahren, das Schwangerschaftsalter bei 21 und die Zahl früherer Schwangerschaften im Mittel bei 2,6. Die Dauer vom Auftreten der ersten Symptome bis zur Aufnahme ins Spital lag bei ungefähr 40 Stunden (6–120 Stunden). Die mittlere Dauer von der Aufnahme bis zur Operation lag im Mittel bei 5.89 (range 1–32) Stunden. Die Perforationsrate lag bei unseren Fällen bei 21%, die Rate negativer Appendektomien bei 13%. Die Perforationsrate war signifikant mit einem fortgeschrittenen Schwangerschaftsalter (p ≤ 0.001) und einer verzögerten Spitalsaufnahme korreliert (p = 0.027). SCHLUSSFOLGERUNGEN: Die Diagnose einer Appendizitis ist während der Schwangerschaft schwierig – die Perforationsrate ist hoch. Wir empfehlen daher die Durchführung einer Appendektomie unmittelbar im Anschluss an den Kaiserschnitt.SummaryOBJECTIVE: Among appendicitis patients pregnant ones occupy only a small proportion. Still there are difficulties in the diagnosis and management of the acute appendicitis in pregnant population. We tried to find answers to these difficulties with our acute appendicitis cases in pregnant patients. STUDY DESIGN: This study involved 46 pregnant patients who received an operation following diagnosis of acute appendicitis in our clinic from 2006 to 2009. Data were collected retrospectively from medical records. Age, time delay to diagnosis, leukocyte count (WBC), gestational age, gestational history, morbidity-mortality and pathology results were evaluated. RESULTS: The mean age of patients, gestational age and number of prior pregnancies were 26, 21 and 2.6, respectively. The amount of time spent in the hospital, from presentation of first symptom to admission, was approximately 40 hours (range 6–120). The mean time from admission to operation was 5.89 (range 1–32) hours. The perforation rate among our cases was 21%. The negative appendectomy rate was 13%. The perforation rate was associated with advanced gestational age and delayed admission to the hospital (p ≤ 0.001 and p = 0.027, respectively). CONCLUSION: The diagnosis of appendicitis in pregnancy is difficult, and the perforation rate is high. Particularly in term pregnancies, we recommend performing appendectomy immediately after cesarean section.

Epidemiological findings and clinical and magnetic resonance presentations in subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. This study investigated the relationships of clinical stage with epidemiological and magnetic resonance imaging (MRI) findings in SSPE by retrospective review of 76 cases (57 male) diagnosed by typical periodic electroencephalographic features, clinical symptoms and elevated measles antibody titre in cerebrospinal fluid. Clinical stage at diagnosis was I or II in 48 patients, III in 25 and IV in three. Prominent findings at presentation were atonic/myoclonic seizures (57.9%) and mental deterioration with behaviour alteration (30.3%). Frequent MRI findings (13 – 32 patients) were subcortical, periventricular and cortical involvement and brain atrophy; the corpus callosum, basal ganglia, cerebellum and brainstem were less frequently involved. Five patients had pseudotumour cerebri. Cranial MRI at initial diagnosis was normal in 21 patients (19 stage I/II, two stage III/IV). Abnormal MRI findings were significantly more frequent in the later stages, thus a normal initial cranial MRI does not exclude SSPE, which should, therefore, be kept in mind in childhood demyelinating diseases even when the presentation is unusual.

The role of diffusion-weighted magnetic resonance imaging in the classification of hepatic hydatid cysts

The aim of the study was to classify different types of hepatic hydatid cysts (HHCs) by measuring the mean apparent diffusion coefficient (ADC) using diffusion-weighted magnetic resonance imaging (DWI). This prospective study comprised 44 patients. The 44 HHCs were classified using Gharbi ultrasonographic classification (GUC) and then T2WIs and DWIs were obtained. The ADC values were measured of the hydatid cyst (HC) subtypes. The distribution of the ADC values in the cyst groups was compared using the Kruskal-Wallis test for multi groups and the Mann-Whitney U test for paired groups. To evaluate the efficacy of ADC values in cyst diagnosis, receiver operating characteristic (ROC) analysis was performed. According to the GUC, there were 15 type 1, 11 type 2, 7 type 3, 5 type 4 and 6 type 5 HHCs. According to the ADC values in the paired comparisons, while types 1, 2 and 5 HCs were statistically differentiated from all other groups except the type 3 group, the type 4 group was differentiated from all other groups and the type 3 group was only differentiated from the type 4 group. When two groups were formed from the HHC subtypes with types 1, 2, and 3 in one group and types 4 and 5 in the other, a statistically significant difference was determined in the mean ADC values of these new groups. In conclusion the measurement of ADC values can be considered a promising parameter as an alternative to ultrasonography in the determination of subtypes of HHCs.

An Evaluation of Subacute Sclerosing Panencephalitis Patients with Diffusion-Weighted Magnetic Resonance Imaging

PurposeThis study aimed to evaluate the contribution of diffusion weighted magnetic resonance imaging to the diagnosis and staging of subacute sclerosing panencephalitis.Material and MethodThe study comprised 26 patients diagnosed with subacute sclerosing panencephalitis at our clinic who were undergoing regular follow-up, and a control group of 18 subjects. Clinical staging was determined by Risk and Haddad classification; 12 at Stage II and 14 at Stage III. Diffusion weighted magnetic resonance images were taken of six areas (frontal, parieto-occipital, cerebellar, deep white matter, thalamus and basal ganglia) and by calculating the apparent diffusion coefficient (ADC) values, and a comparison was made between the stages and with the control group.ResultsThe ADC values of all the areas of the subacute sclerosing panencephalitis patients were found to be significantly higher compared to the control group (p < 0.05). While the mean ADC values of the deep white matter, basal ganglia, frontal and parieto-occipital areas of the Stage II patients were found to be significant compared to the control group (p < 0.05), there was no significance in the other areas (p > 0.05). The ADC values of all the areas of the Stage III patients were found to be significantly high compared to the Stage II values (p < 0.05).ConclusionDiffusion weighted magnetic resonance imaging can be used with other diagnostic criteria to confirm diagnosis of subacute sclerosing panencephalitis and to reveal differences between the stages.