Ilkay Koray Bayrak

Ultrasonography in patients with ulnar neuropathy at the elbow: Comparison of cross‐sectional area and swelling ratio with electrophysiological severity

The aim of this study was to determine the diagnostic value of ultrasonographic measurements in ulnar neuropathy at the elbow (UNE) and to assess the relationship between the measurements and the electrophysiological severity. The largest anteroposterior diameter (LAPD) and cross‐sectional area (CSA) measurements of the ulnar nerve were noted at multiple levels along the arm, and the distal‐to‐proximal ratios were calculated. Almost all of the measurements and swelling ratios between patients and controls showed statistically significant differences. The largest CSA, distal/largest CSA ratio, CSA at the epicondyle, and proximal LAPD had larger areas under the curve than other measurements. The sensitivity and specificity in diagnosing UNE were 95% and 71% for the largest CSA, 83% and 85% for the distal/largest CSA ratio, 83% and 81% for the CSA at the epicondyle, and 93% and 43% for the proximal LAPD, respectively. There was a statistically significant correlation between the electrophysiological severity scale score (ESSS) and the largest CSA, the CSA at the epicondyle and 2 cm proximal to the epicondyle, and the LAPD at the level of the epicondyle (P < 0.05). None of the swelling ratios showed a significant correlation with the ESSS. The largest CSA measurement is the most valuable ultrasonographic measurement both for diagnosis and determining the severity of UNE. Muscle Nerve, 2010

Ultrasonography in carpal tunnel syndrome: comparison with electrophysiological stage and motor unit number estimate.

The purpose of this study was to document the ultrasonographic measurement differences in median nerve size between patients with carpal tunnel syndrome (CTS) and controls, and to correlate these findings with electrophysiological stage and motor unit number estimation (MUNE), thereby allowing us to test the validity of ultrasound as a diagnostic modality for assessing the severity of CTS. High‐resolution sonography and electrophysiological studies were performed on 41 wrists of 27 patients and compared with findings on 40 wrists of 20 healthy individuals. On ultrasonographic views, cross‐sectional area and flattening ratio in proximal, middle, and distal tunnel segments of the median nerve were measured both by calculating ellipsoid area by large and small cross‐sectional diameters and by automated ellipsoid area calculation. We compared electrophysiological stage and MUNE with proximal, middle, and distal cross‐sectional area and other ultrasonographic findings. All correlations between electrophysiological stage and cross‐sectional areas in these different segments of the median nerve were significant with both measurement methods. Negative correlations were seen between MUNE and cross‐sectional area in the proximal and middle segments, whereas no significant correlation was detected in the distal segment. Our results indicate that there are close correlations between the ultrasonographic findings and electrophysiological stage. Ultrasound also reflects the reduction in the number of axons estimated by the MUNE method. Therefore, we suggest that the ultrasonographic findings reflect the severity of disease in patients with CTS. Muscle Nerve, 2006

Bifid Median Nerve in Patients With Carpal Tunnel Syndrome

Objective. The aim of this study was to investigate the frequency of the anatomic variation of a bifid median nerve in patients with carpal tunnel syndrome (CTS) and to determine the size criteria for sonography. Methods. On axial sonograms of 320 hands of 170 patients with CTS and 240 hands of 120 unaffected individuals, the median nerve was evaluated morphologically for a bifid median nerve, and the cross‐sectional area was measured at 3 levels (radial‐ulnar junction, pisiform, and hook of the hamate). Electrophysiologic studies were performed in addition to clinical and sonographic evaluations in all patients, controls with a bifid median nerve, and controls with a cross‐sectional area of greater than 0.09 cm2. Results. A bifid median nerve was seen in 32 (19%) of 170 patients and 11 (9%) of 120 controls. It occurred relatively frequently in patients with CTS (P < .01). The cross‐sectional area of the bifid median nerve was relatively higher than that of the nonbifid median nerve in controls at 2 of the 3 levels (P < .001; P = .226; P < .01). The cutoff values for the cross‐sectional area at the level of the pisiform were 0.11 cm2 (sensitivity, 90%; specificity, 99%; P < .001) for patients with a bifid median nerve and 0.10 cm2 (sensitivity, 98%; specificity, 81%; P < .001) for patients with a nonbifid median nerve. Conclusions. A bifid median nerve occurs relatively frequently in patients with CTS. It may facilitate compression of the median nerve in the carpal tunnel because of its relatively higher cross‐sectional area compared with a nonbifid median nerve. The size criterion for CTS in patients with a bifid median nerve is slightly higher than in those with a nonbifid median nerve.

Effect of cervical spondylosis on vertebral arterial flow and its association with vertigo

The aim in this study was to evaluate the effect of cervical spondylosis on vertebral arterial flow. The flow changes on Doppler measurements in patients with vertigo were also assessed. Ninety-one patients with different grades of degeneration on disks and apophysis were evaluated. The severity of degeneration was determined by two observers, and the effect of cervical degeneration on vertebral arterial flow was assessed. The relation between vertigo and changes in Doppler measurements of vertebral artery in neck and cranium was analyzed. As total degeneration increases, the flow volume decreases in the right vertebral artery but increases in the left. No other correlation between degeneration scores, cervical curve measurements, and Doppler measurements was noted. According to the total degeneration scores, no differences were noted between the patients with and without vertigo. In patients with vertigo, the resistive index was higher in the neck before the vertebral foramina. In correlations of the ratios of the intra/extracranial vertebral artery with Doppler measurements, the only change was observed in the left flow volume. The severity of degeneration in disks and apophysis does not cause a considerable change in vertebral arterial flow, and also no significant finding on Doppler measurements were noted in patients with vertigo.

Mammary duct ectasia in infant breast with bloody nipple discharge: Sonographic findings

Bloody nipple discharge is very rare in childhood. We report the sonographic findings of mammary duct ectasia and cystic changes under the nipple with abnormal content involving a 3‐month‐old boy with bloody nipple discharge.

Assessment of the effect of glucosamine sulfate and exercise on knee cartilage using magnetic resonance imaging in patients with knee osteoarthritis: A randomized controlled clinical trial

INTRODUCTION Osteoarthritis (OA) is a chronic disease characterized by the focal deterioration and abrasion of articular cartilage. The goals of therapy are preserving normal joint function, relieving pain and improving quality of life (QOL). This study is performed to investigate whether glocosamine sulfate and exercise could both delay joint structure degradation evaluated with magnetic resonance imaging (MRI) and improve symptoms in a short time period. MATERIALS AND METHODS Thirty-nine women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n=20) received an exercise program, while group II (n=19) received glucosamin sulphate (1500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. The patients were evaluated before and after the treatment regarding pain, disability, functional performance, muscle strength, QOL, depression and MRI findings (cartilage volume, medial and lateral cartilage thickness). RESULTS Both groups showed significant improvements in pain, disability, functional performance, QOL and depression with no statistically significant difference between the groups after the therapy. While there were significant improvements for all MRI parameters expect right knee cartilage volume and lateral cartilage thickness in two groups, statistically significant differences could not be demonstrated between the groups after the therapy. CONCLUSION We found no additional effect of glucosamine in delaying the radiological progression and relieving the symptoms of OA. We also demonstrated that exercise alone was adequate to prevent structural changes and cartilage loss of the knee joint as assessed by MRI.

The role of ultrasonography in the diagnosis and management of non-traumatic acute abdominal pain

Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the discharge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diagnosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6–39.3%) of the patients. The US revealed a different diagnosis than the clinical impression in 69 (23%; 95%CI, 18.2–27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4–45.5%) patients. The US changed the treatment plans in 47% (95%CI, 41.3–52.6%) of the patients. The clinicians stated US helped them “very much” or “moderately” in making a diagnosis in 83% (95%CI, 78.7–87.2%). When US results were compared with the discharge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3–83.6%) patients but not in 62 (20.6%; 95%CI, 16–25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80–92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, targeted US study according to the initial clinical impression decreases the clinical benefit of US.

Acute Lymphoblastic Leukemia Presented as Multiple Breast Masses

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patients mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.

Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity

Abstract Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography. Patients and methods: The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization. Results: A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages. Conclusion: Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.

A rare complication of acute cholecystitis: transhepatic perforation associated with massive intraperitoneal hemorrhage.

A 2 to 11% of the patients with acute cholecystitis that will develop gallbladder perforation and massive intraperitoneal hemorrhage as a result of perforation will rarely be seen. Massive intraperitoneal hemorrhage associated with the transhepatic perforation is very uncommon. By this article, we anticipate presenting clinical and radiological findings in a case that has acute cholecystitis with massive intraperitoneal hemorrhage associated with transhepatic perforation.