Naciye Sinem Gezer

Comparison of treatments with the Forsus fatigue resistant device in relation to skeletal maturity: A cephalometric and magnetic resonance imaging study

INTRODUCTION The aim of this study was to compare the dentoskeletal changes and alterations of mandibular condyle-disc-fossa relationships in subjects at the peak and the end of the pubertal growth period treated with the Forsus fatigue resistant device (3M Unitek, Monrovia, Calif). METHODS The sample consisted of 29 subjects with Class II Division 1 malocclusions who were classified according to their hand-wrist radiographs. Fifteen patients were at or just before the peak phase of pubertal growth (peak pubertal group). Fourteen patients were near the end of the pubertal growth period (late pubertal group). The study was conducted by using lateral cephalometric radiographs and magnetic resonance images obtained at the beginning and at the end of the application of the Forsus fatigue resistant device. The treatment period was 9 months. RESULTS The Wilcoxon signed rank test was used to evaluate differences within groups. The changes observed in both groups were compared by using the Mann-Whitney U test. There were statistically significant group differences in mandibular length and ramus length, with significant increases of these parameters in the peak pubertal group (P <0.05). No significant differences were observed between the groups concerning dental parameters (P >0.05), with the exception of mandibular molar vertical movements, which were significantly greater in the peak pubertal group (P <0.05). Analysis of the magnetic resonance images showed no positional changes of the mandibular condyle in relation to the glenoid fossa in either group (P >0.05). Although the articular disc was positioned more anteriorly in the peak pubertal group compared with its pretreatment position (P <0.05), the position of the disc was still within the physiologic range. No significant intergroup difference was observed for disc-condyle relationship (P >0.05). CONCLUSIONS The Forsus fatigue resistant device did not appear to cause significant increases in mandibular dimensions in subjects in late puberty. According to the magnetic resonance image findings, Forsus treatment is not a risk factor for the development of temporomandibular dysfunction in subjects with no signs and clinical symptoms of dysfunction.

Abdominal sarcoidosis: cross-sectional imaging findings

Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%-70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis.

Functional magnetic resonance imaging of the effects of low-frequency transcutaneous electrical nerve stimulation on central pain modulation: a double-blind, placebo-controlled trial.

Objectives: Transcutaneous electrical nerve stimulation (TENS) is an analgesic current that is used in many acute and chronic painful states. The aim of this study was to investigate central pain modulation by low-frequency TENS. Methods: Twenty patients diagnosed with subacromial impingement syndrome of the shoulder were enrolled in the study. Patients were randomized into 2 groups: low-frequency TENS and sham TENS. Painful stimuli were delivered during which functional magnetic resonance imaging scans were performed, both before and after treatment. Ten central regions of interest that were reported to have a role in pain perception were chosen and analyzed bilaterally on functional magnetic resonance images. Perceived pain intensity during painful stimuli was evaluated using visual analog scale (VAS). Results: In the low-frequency TENS group, there was a statistically significant decrease in the perceived pain intensity and pain-specific activation of the contralateral primary sensory cortex, bilateral caudal anterior cingulate cortex, and of the ipsilateral supplementary motor area. There was a statistically significant correlation between the change of VAS value and the change of activity in the contralateral thalamus, prefrontal cortex, and the ipsilateral posterior parietal cortex. In the sham TENS group, there was no significant change in VAS value and activity of regions of interest. Discussion: We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.

Chromosome abnormality incidence in fetuses with cerebral ventriculomegaly

Abstract Ventriculomegaly (VM) is a marker of aneuploidy and warrants a detailed examination of fetal anatomy. Chromosomal abnormalities worsen the fetal and neonatal prognosis significantly and karyotyping of fetuses is critically important when accompanying anomalies are detected. Here, we report the genetic results of 140 fetuses with isolated and non-isolated VM detected during a second trimester ultrasound examination followed by invasive in utero diagnostic procedures for karyotyping. VM was diagnosed in seven (5%) fetuses with abnormal karyotype and the chromosomal abnormality incidence was higher in severe VM (6.8%) than mild (4.2%). Higher chromosomal abnormality rates were detected when VM was isolated (8.6%), rather than associated with any anomaly (3.8%). These results suggest that karyotype analysis should be offered to all patients with any degree of VM, regardless of its association with structural anomalies.

Role of mass effect, tumor volume and peritumoral edema volume in the differential diagnosis of primary brain tumor and metastasis

INTRODUCTION The differentiation of metastatic and primary brain tumors with certainty is important since clinical management and treatment of these two types of tumors are radically different. The purpose of the present study was to evaluate the effect of peritumoral edema volume, tumor volume and mass effect of tumor on differential diagnosis of metastatic and primary brain tumors. Also we have planned to investigate if the relationship between edema volume and mass affect can contribute to the differential diagnosis. MATERIAL AND METHODS We retrospectively reviewed MR images of patients with primary (n=40) and metastatic (n=40) intra-axial supratentorial brain tumor. Supratentorial primary solitary brain tumor group was also subdivided as GBM subgroup (n=24) and other than GBM subgroup (n=16) for statistical analysis. Metastasis at suitable localization which can lead to midline shift (due to mass effect) were selected. Tumor volume, peritumoral edema volume and mass-edema index (peritumoral edema volume/tumor volume) were calculated. Displacement of the midline structures (subfalcian herniation) was measured. Metastasis, GBM and other than GBM groups were evaluated for subfalcian shift, shift grade, tumor volume, peritumoral edema volume and mass-edema index by using Kruskal-Wallis test after Bonferroni correction. Mann-Whitney U test was used to analise subfalcian shift, tumor volume, peritumoral edema volume and mass-edema index of primary tumor and methastasis groups since the data was not normally distributed. Shift grade of the two groups was analised with chi-square test. RESULTS Midline shift, tumor volume and mass-edema index were significantly different between metastasis and primary tumor groups (p=0.001, p<0.001, p=0.001 respectively). Midline shift and tumor volume of the primary tumor group were greater than metastasis group while mass-edema index was less. Shift grade of metastasis and primary tumor groups was also significant (p=0.041). A midline shift more than 5mm (grade 2) was more common in primary tumors. There was no significant difference between GBM and other than GBM groups. CONCLUSION Measurement of midline shift, tumor volume and mass-edema index may contribute to the differential diagnosis of brain metastasis from primary brain tumors. Also mass-edema index can be a useful tool for differential diagnosis in the future. But further studies with larger series are needed.

Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features.

Background: This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may resemble each other. Methods: Preoperative mammograms, B-mode and Doppler sonograms, and dynamic breast MRIs of 72 patients with pathologically proven fibroadenomas and 70 patients with pathologically proven phyllodes tumor were evaluated in this retrospective study. Statistical significance was evaluated using chi-square and Fishers exact tests. Correlations in lesion size among radiological methods were examined by Pearsons correlation analysis. Results: The features that differed on mammogram were size, shape, and margin of the mass. Sonograms showed significant differences in size, shape, margin, echo pattern, and vascularization of the mass. Pearsons correlation analysis showed strong agreement among radiological methods in terms of assessment of size. Tumor size ≥ 3 cm, irregular shape, microlobulated margins, complex internal echo pattern, and hypervascularity were significant findings of phyllodes tumors. Internal cystic areas on MRI were frequently associated with phyllodes tumors. Conclusion: Mammographic, sonographic, and MRI findings of fibroadenomas and phyllodes tumors could help radiologists to ascertain imaging-histological concordance and guide clinicians in their decision making regarding adequate follow-up or the necessity of biopsy.

Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction

Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes.

Chromosomal and structural anomalies in fetuses with open neural tube defects

The aim of this study is to evaluate the frequency and types of associated anomalies with the results of ultrasonographic and postmortem examination and identify the necessity of prenatal karyotyping among fetuses with open neural tube defects (NTD). Fetuses diagnosed with NTDs between 2008 and 2012 were retrospectively analysed. A total of 167 fetuses that were prenatally karyotyped, terminated and examined at postmortem were evaluated. Associated anomalies were detected and classified by detailed ultrasonography and autopsy findings. In total, 57 fetuses (34.1%) had associated anomalies. Prenatal ultrasonography detected 73.1% of additional anomalies compared with autopsy. Three fetuses had chromosomal abnormalities with multiple additional anomalies. A complete anatomical survey and genetic evaluation is needed for the fetuses with NTDs. We found lower chromosomal abnormality rates but due to some factors specific to NTDs, ultrasonography may not be predictive as to whether the fetus is isolated or not. We still therefore also offer chromosome analysis in isolated cases.

Management of free-floating thrombus within the arcus aorta and supra-aortic arteries

INTRODUCTION Clinical management strategy and the best treatment option of free floating thrombus (FFT), detected in patients with acute ischemic cerebrovascular diseases is still uncertain due to the rarity of these conditions. Recent studies emphasize that FFT within cerebral vessels may not be a surgical emergency since complete dissolution without any further neurologic progression occurred in 86% of patients treated medically. The aim of this study was to investigate the effect of medical treatment on the fate of thrombus and the clinical status in acute cerebrovascular event patients with detected FFT in the artery feeding the compromised brain territory at the time of diagnosis. MATERIALS AND METHODS We have retrospectively reviewed the initial and follow up computed tomography angiography, diffusion-weighted magnetic resonance imaging examinations of 37 acute ischemic stroke patients with detected FFT and treated medically. The patients were evaluated for any change of the FFT, residual stenosis after the FFT shrunk or disappeared and neurologic outcome. RESULTS FFT was located in cervical carotid artery, intracranial artery and arcus aorta in 23, 6 and 5 of the patients respectively. Dissection accompanied the FFT in 3 patients. Recanalization was maintained in 34 patients however, three of them suffered from new infarctions. A total occlusion was detected in three patients. Two of them had new infarcts while one was stable during clinical follow-up period. CONCLUSION The results of our retrospective study have shown that FFT in the proximal aorta and supra-aortic arteries tend to resolve with anticoagulant and/or antiplatelet treatment without causing recurrent adverse events in most of the cases. Furthermore, resolution of the clot seems to provide a safer ground for a recanalization procedure like stenting or endarterectomy if needed.

Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

Background: Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X‐ray in patients presenting to the ED with non‐traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT. Methods: The study enrolled 500 consecutive patients with both chest X‐rays and CT who presented to the ED with non‐traumatic complaints. Chest X‐rays and CT images obtained within 12 h before any definitive treatment were randomly evaluated in consensus by two radiologists blinded to the clinical information. Results: The chest X‐ray and CT image findings were concordant in 49.2% of the 500 patients and this concordance was negatively correlated with patient age. Leading diagnosis and management decisions based on the chest radiograph changed after CT in 35.4% of the study group and this finding was also correlated with age. In 55% of 205 patients, pneumonic infiltrations were undiagnosed with radiography. Pulmonary edema was the most specific (93.3%) and sensitive (85.4%) radiography finding. Posteroanterior chest radiographs taken in the upright position had higher concordance with CT than anteroposterior (AP) radiographs taken in the supine position. Conclusions: Chest CT may be an appropriate imaging choice in patients presenting to the ED for non‐traumatic reasons, particularly for elderly patients and when the radiograph is taken with the AP technique in a supine position. HighlightsFindings of chest radiographs and CT images were concordant in 49.2% of 500 patients.Leading diagnosis and management decisions changed after CT in 35.4% of patients.In 55% of 205 patients, pneumonic infiltration was undiagnosed with radiography.Pulmonary edema was the most specific and sensitive finding of radiography.