Mehmet Selim Nural

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

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.

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.

Simplified gyral pattern with cerebellar hypoplasia in Sedaghatian type spondylometaphyseal dysplasia: A clinical report and review of the literature†

We report on a patient with Sedaghatian type spondylometaphyseal dysplasia (SSMD) who presented with metaphyseal dysplasia, congenital atrioventricular block, simplified gyral pattern, hypogenesis of corpus callosum, and severe cerebellar hypoplasia. We want to emphasize that in this rare congenital lethal skeletal dysplasia with unknown etiology, central nervous system malformations might be a major component of the disorder and should be evaluated in detail to possibly uncover the underlying pathophysiology.

Efficiency of apparent diffusion coefficients in differentiation of colorectal tumor recurrences and posttherapeutical soft-tissue changes

OBJECTIVE To evaluate effectiveness of apparent diffusion coefficient (ADC) values measured by diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiation of colorectal tumor recurrences and posttherapeutical soft tissue changes. METHODS For this prospective study, 30 patients (22 males, 8 females; age range 30-81 years; mean age 61±12 years) who underwent surgery for colorectal tumors and had a mass detected by computed tomography (CT) and/or MRI during follow-up examinations were divided into 2 groups [17 patients (Group 1) with recurrence and 13 patients (Group 2) with benign fibrosis/granulation tissue]. Final diagnoses were based on histopathological examination in 14 patients and clinical follow-up at least 6 months in the remaining 16. In the latter, the diagnosis of recurrence was made in cases in which the lesion was larger on follow-up CT and MRI; recurrence was ruled out in cases of stable or shrinking lesions without any increase in tumor markers. DW-MRI was performed in the axial plane, for two different b values (b=0 and 800 s/mm(2)). The mean apparent diffusion coefficient (ADC) values were measured by manual delineation of regions of interest on ADC maps. RESULTS The median ADC values were 1.07 × 10(-3)mm/s(2) (min: 0.82, max: 2.05) and 1.91 × 10(-3)mm/s(2) (min: 1.51, max: 2.22) in Groups 1 and 2, respectively. A statistically significant difference was detected between the two groups (P<0.001). When the threshold value used to determine whether the lesions recurred was 1.48 × 10(-3)mm/s(2) based on ROC analysis, the sensitivity was 82% and the specificity was 100%. There were three patients with a false-negative diagnosis, and the primary histopathological diagnosis of all was mucinous adenocarcinoma. CONCLUSIONS Because recurrences in mucinous adenocarcinomas have high ADC values, they may show overlap with benign lesions. In the detection of the local recurrence of colorectal neoplasms, with the exception of mucinous adenocarcinomas, ADC measurements are reliable imaging techniques.

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.

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

BACKGROUND In this study, we investigated the role of abdominal computed tomography (CT) in determining perforation findings and site in patients with gastrointestinal tract perforation. METHODS Preoperative abdominal CT scans of 47 patients who had surgically proven gastrointestinal tract perforation between July 2007 and July 2010 were reviewed retrospectively. The presence of free air, leakage of contrast material, wall thickness, wall discontinuity, abscess, free fluid, and phlegmon were investigated for each patient. The site of perforation was estimated in light of these findings and compared with the surgical outcomes. RESULTS Perforation sites were determined correctly in 85.7% of patients with gastroduodenal perforation, 85.7% of patients with small bowel perforation, 69.2% of patients with large bowel perforation, 100% of patients with rectum perforation, 90.9% of patients with appendix perforation, and 82.9% of all patients according to the abdominal CT findings. The most common CT finding in gastrointestinal tract perforation was free fluid, with a rate of 89.4%. The rates of other findings were as follows: free air 76.6%, segmental wall thickening 48.9%, wall discontinuity 25.5%, abscess 12.8%, and phlegmon 10.6%. Of 30 patients who received oral contrast, 7 (23.3%) had extraluminal contrast leakage. CONCLUSION CT is very effective in determining gastrointestinal tract perforation findings and the site of perforation.

Idiopathic isolated laryngotracheobronchial cartilage calcification in a child

Laryngeal, tracheal, and bronchial cartilage calcification is quite rare in children. It was reported to occur in congenital cardiovascular diseases, Keutel syndrome, chondroplasia punctata, warfarin embryopathy, and warfarin sodium therapy. It can occur idiopathically as well. Laryngotracheobronchial cartilage calcification is demonstrated in this report by chest radiography and multiplanar three-dimensional CT examination in a 2.5-year-old boy with nonspecific cough.

Left Subclavian Artery Aneurysm Rupture in Association with Aortic Coarctation

Aneurysms occurring in association with aortic coarctation are generally seen during the postoperative period and occur in a true or pseudoaneurysm form. Presumably, the stiff patch transmits additional tension to the adjacent elastic aortic wall, which thus bears the total burden of the pulse wave and dilates [1]. However, several cases have been reported in which an aneurysm developed in the absence of coarctation repair; these aneurysms are generally located in the ascending aorta [2]. Subclavian artery aneurysms (SAAs) are rare peripheral aneurysms and most are caused by atherosclerosis. They are rarely seen as complications of aortic coarctation and rarely result in aneurysm rupture [3, 4]. In the present issue, we have reported the clinical, operative, and imaging findings of a patient with left SAA rupture secondary to aortic isthmic coarctation.