Mustafa Bekir Selcuk

Early spondyloarthropathy: scintigraphic, biological, and clinical findings in MRI-positive patients

There are no specific diagnostic tests or a gold standard method for measuring disease activity and outcome in spondyloarthropathies (SpA). Many different methods have been developed to assess the signs and symptoms in SpA. The aim of this study was to evaluate the value of scintigraphy, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankilosing Spondylitis Disease Activity Index (BASDAI) in the evaluation of disease activity in early axial SpA diagnosed with magnetic resonance imaging (MRI). Thirty early MRI-positive axial SpA patients (23 males, 7 females) with a median age of 35 (18–55) years and a median duration of inflammatory low back pain of 24 (8–60) months were included in the study. In the patients with sacroiliitis, the sensitivity, specificity, and positive and negative predictive values of disease activity parameters were determined regarding MRI as the gold standard method. The sensitivities of quantitative scintigraphy, visual scintigraphy, ESR, CRP, and BASDAI were 32, 82, 35, 71, and 60%, respectively. The specificities of quantitative scintigraphy, ESR, CRP, and BASDAI were 100, 100, 50, and 100%, respectively. The positive predictive values of quantitative scintigraphy, visual scintigraphy, ESR, CRP, and BASDAI were 100, 92, 100, 95, and 100%, respectively. The negative predictive values of quantitative scintigraphy, ESR, CRP, and BASDAI were 9, 10, 11, and 15%, respectively. Regarding MRI as the gold standard in the evaluation of disease activity, combined visual and quantitative bone scintigraphy can be valuable in patients with MRI-incompatible implants. Additionally, use of cheaper, simple, and readily reproducible tests such as CRP and BASDAI together could be valuable and practical in detecting disease activity in long-term follow-up of these patients.

Bilateral adrenal hemorrhage associated with bilateral renal vein and vena cava thrombosis

Idiopathic bilateral adrenal hemorrhage with thrombosis of both renal veins and inferior vena cava are presented using US and CT in a newborn. To our knowledge such bilateral involvement of the adrenal glands and the renal veins have not been reported previously.

Ascariasis of the gallbladder: radiological evaluation and follow-up

A 10-year-old boy presented with fever, jaundice, abdominal pain and vomiting. There was hepatomegaly and right upper quadrant tenderness. US identified a dilated gallbladder containing a moving, linear echogenic structure with a central anechoic lumen (Fig.1). Cholangitis secondary to ascariasis was diagnosed. US also showed multiple adult roundworms in the smallbowel lumen. Gallbladder ascariasis was also confirmed by CT and MRI. Ascaris eggs were detected in the faeces. Antibiotic treatment was given, but antiparasitic drugs were not prescribed. Three days later, US showed the Ascaris in the main hepatic duct; after another 4 days, the worm had disappeared from the biliary tree. After antiparasitic treatment had been given, the patient was discharged with no clinical or US abnormality. Adult roundworm invasion into the gallbladder is very rare and accounts for 2.1% of hepatobiliary ascariasis [1]. Worm migration can also result in biliary obstruction [2]. Biliary ascariasis is best shown by US identification of worms inside the biliary tree or gallbladder [3]. US findings include a nonshadowing, long, mobile echogenic strip with central anechoic tube [1]. Cholecystectomy, choledochotomy and other interventions have been used in the treatment of hepatobiliary ascariasis [4]. The motion of the Ascaris can be observed by US and this will indicate whether it is alive or not, an advantage of US over CT and MRI. US is also useful to monitor the progress of the worm in the hepatobiliary system. After the worm returns to the small bowel, it can be effectively treated with antiparasitic drugs. Thus, surgery, other interventions and their complications can be prevented by timing antiparasitic treatment in accordance with the findings of US monitoring.

MELANOTIC NEUROECTODERMAL TUMOR OF INFANCY OF THE FEMUR

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare neoplasm that often occurs during the first year of life. More than 90% of MNTIs occur in the head and neck region, with most on the anterior part of the maxillary ridge. MNTI has also been reported in the mediastinum, thigh, foot, shoulder, and gonads. Here the authors report a rare case of MNTI of the femur in a 3-month-old child.

Osteoskeletal manifestations of scurvy: MRI and ultrasound findings

Scurvy has become very rare in the modern world. The incidence of scurvy in the pediatric population is extremely low. In the pediatric population, musculoskeletal manifestations are more common and multiple subperiosteal hematomas are an important indicator for the diagnosis of scurvy. Although magnetic resonance imaging findings of scurvy are well described in the literature, to our knowledge, ultrasound findings have not yet been described. In this article, we report a case of scurvy with associated magnetic resonance imaging and ultrasound findings.

Erdheim-Chester disease: 99mTc-MDP bone scan provides the diagnosis

1 Department of Nuclear Medicine, Ondokuz Mayıs University, Samsun, Turkey 2 Department of Trauma and Orthopaedics Surgery, Ondokuz Mayıs University, Samsun, Turkey 3 Department of Pathology, Ondokuz Mayıs University, Samsun, Turkey 4 Department of Radiology, Ondokuz Mayıs University, Samsun, Turkey 5 Kurupelit Kampus, Tip Fakultesi, Nukleer Tip ABD, Ondokuz Mayıs Universitesi, 55139 Samsun, Turkey

ACQUIRED VON WILLEBRAND SYNDROME IN A PATIENT WITH EWING SARCOMA

Acquired von Willebrand syndrome is a rare bleeding disorder with clinical and laboratory features closely resembling to hereditary von Willebrand disease. The syndrome may accompany various conditions, including malignant disorders, most often with Wilms tumor and adrenal cell carcinoma. In this report, the authors present a patient with AvWS in association with Ewing sarcoma for the first time in the literature. The abnormal bleeding tendency was successfully treated with fresh frozen plasma and did not recur after the first two courses of chemotherapy with clinical improvement.

Evaluation of the patients with renovascular hypertension after percutaneous revascularization by Doppler ultrasonography

OBJECTIVE Evaluation of the effectiveness of percutaneous revascularization is based primarily on clinical criteria, and laboratory findings rather than direct investigation of luminal width. The purpose of this study was to evaluate the success of endovascular revascularization with serial Doppler ultrasound (US) examinations. METHODS AND MATERIAL 19 patients (14 were atherosclerotic, five were with fibromuscular dysplasia) with suspected renovascular hypertension treated by percutaneous revascularization were included in a prospective study. Patients had 23 renal artery stenoses reducing the diameter by more than 50%. Doppler US examinations were performed before intervention, and 1 day, 3 and 6 months after intervention. RESULTS Initial revascularization was technically successful in 21 of 23 stenoses (91.3%) (18 PTRA, three stent placement). Hypertension was cured in five atherosclerotic and in five fibromuscular dysplasia (FMD) patients, and improved in four atherosclerotic patients. Residual stenosis was determined in six patients and the others were evaluated as normal by initial postprocedure Doppler US. As based on Doppler US, restenosis (>60%-narrowing) was depicted in four of six (66.6%) renal arteries with residual stenosis, and one of 15 (6.6%) normal renal arteries at 1 year. This difference in restenosis rates (residual stenosis vs. normal) was significant (P<0.05). CONCLUSION Positive predictor for recurrence was a residual renal artery stenosis documented by Doppler US 1 day after percutaneous revascularization in atherosclerotic cases.

Effects of short and long term electromagnetic fields exposure on the human hippocampus

The increasing use of mobile phones may have a number of physiological and psychological effects on human health. Many animal and human studies have reported various effects on the central nervous system and cognitive performance from of exposure to electromagnetic fields (EMF) emitted by mobile phones. The aim of the present study was to evaluate the effects of mobile phones on the morphology of the human brain and on cognitive performance using stereological and spectroscopic methods and neurocognitive tests. Sixty healthy female medical school students aged 18–25 years were divided into a low exposure group (30 subjects, <30 min daily use by the head) and high exposure group (30 subjects, >90 min daily use by the head). Magnetic resonance images (MRI) of the brain analysed on OsiriX 3.2.1 workstation. Neuropsychological tests were performed for each subject. In addition, three dominant specific metabolites were analysed, choline at 3.21 ppm, creatine at 3.04 ppm and N-acetyl aspartate at 2.02 ppm. Analysis of the spectroscopic results revealed no significant difference in specific metabolites between the groups (p > 0.05). There was also no significant difference in terms of hippocampal volume between the groups (p > 0.05). In contrast, the results of the stroop and digit span (backward) neurocognitive tests of high exposure group for evaluating attention were significantly poorer from low exposure group (p < 0.05). Based on these results, we conclude that a lack of attention and concentration may occur in subjects who talk on mobile phones for longer times, compared to those who use phones relatively less.

Distribution and evaluation of bone and soft tissue tumors in the middle Black Sea Region

OBJECTIVE The aim of this study was to evaluate the characteristics of bone and soft tissue tumors operated on at the Department of Orthopedics and Traumatology at Ondokuz Mayıs University Faculty of Medicine Hospital between January 1987 and January 2012. METHODS This descriptive study retrospectively evaluated 1,925 patients hospitalized with a preliminary diagnosis of tumor. Patients were analyzed for age, gender, tumor incidence and localization. Three hundred and forty-nine patients found to have non-tumor causes. The 94 patients discharged at their own request or deceased during follow-up were not included in the tumor group. RESULTS Of the 1,482 (76.9%) patients diagnosed with tumor, 687 (46.4%) were bone tumors, 586 (39.5%) soft tissue tumors and 209 (14.1%) metastatic tumors. The most common benign bone tumor was osteochondroma (118; 25%), followed by enchondroma (68; 14.4%) and giant cell tumor (59; 12.5%), and the most common malignant bone tumor was osteosarcoma (58; 27%), followed by chondrosarcoma (36; 16.7%) and Ewings sarcoma (33; 15.3%). The most common benign soft tissue tumor was cystic hygroma (96; 22%), followed by lipoma (75; 17.2%) and hemangioma (52; 11.9%), and the most common malignant soft tissue tumors were pleomorphic cell tumor (29; 19.3%) and liposarcoma (29; 19.3%), followed by pleomorphic undifferentiated sarcoma (21; 14%). Seventy (33.5%) of the metastatic tumors were of pulmonary origin, 36 (17.2%) were of breast origin and the primary site of the tumor was not clearly determined in 58 (27.8%) patients. CONCLUSION The distribution of bone and soft tissue tumors appear to have certain characteristics but can show regional differences. We believe that the establishment of a larger series through the collection of these types of studies from centers in which bone and soft tissue tumor surgery is performed will provide important information on the epidemiological features of bone and soft tissue tumors.