Naile Bolca Topal

MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury

Abstract Purpose: To evaluate the occurrence and distribution of mild traumatic brain injury (MTBI) caused by diffuse axonal injury (DAI) using magnetic resonance (MR) imaging and to attempt to correlate MR findings with post-concussion symptoms (PCS). Patients and methods: Forty MTBI patients (mean age: 32.5 years) with normal cranial computed tomography (CT) findings were examined with standard MR protocol including T1-weighted, T2-weighted, fluid attenuated inversion recovery (FLAIR), gradient echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed within 24 hours of injury. The lesions were classified as DAI based on their location and morphologic appearance. Results: In MR imaging of five (12.5%) of the patients, the lesions compatible with DAI were observed. Four patients (10%) had the foci of low signal intensity compatible with hemorrhagic shear injury on the GRE sequence, and five (12.5%) patients had high signal intensity on FLAIR and DW sequence. Conclusion: MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.

The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts.

PURPOSE The purpose of this study is to identify the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the classification of liver hydatid cysts (HCs) and their differentiation from simple cysts and liver abscesses. MATERIALS AND METHODS Twenty-two patients that were sent to our department with preliminary diagnoses of HCs or abscess were included in the study. Thirty lesions were evaluated. MRI included T1-weighted fast gradient echo, T2-weighted half-Fourier acquisition single-shot turbo spin echo, and DW single-shot echo planar pulse sequencing (b, 0, 50, and 1000 s/mm²). The apparent diffusion coefficient (ADC) values (mm²/s) of the HCs, abscesses, and simple cysts were calculated. RESULTS No statistically significant difference was found between the ADC values of type 1 and 3 (P > 0.05) HCs and of simple cysts and type 1 HCs (P > 0.05). The ADC values of abscesses were significantly lower than those of type 1 and type 3 HCs, and simple cysts. No statistically significant difference was found between the ADC values of abscesses and type 4 HCs (P > 0.05). Type 4 lesions exhibited significantly lower ADC values in comparison to type 1 and 3 HCs. CONCLUSION DW-MRI helps differentiate type 4 lesions from other cysts and can distinguish abscesses from hydatid cysts other than type 4 as well as from simple cysts. Type 1 HCs cannot be differentiated from simple cysts using ADC values alone, and type 4 lesions are indistinguishable from abscesses.

Effects of hormone replacement therapy regimens on mammographic breast density: The role of progestins

Aim:  To evaluate the effects of different regimens of hormone replacement therapy (HRT) on mammographic breast density.

Effects of Origanum onites on Endothelial Function and Serum Biochemical Markers in Hyperlipidaemic Patients

The effects of Origanum onites on endothelial function and antioxidative status were investigated in 48 patients with mild hyperlipidaemia who required no drug therapy. All participants were given lifestyle and low-fat dietary advice, however 32 of the patients (study group) were also prescribed 25 ml of aqueous distillate of Origanum onites to be taken after each meal for 3 months. The remaining 16 patients were the control group. Various biochemical markers and endothelial function parameters were measured at baseline and after 3 months. A significantly greater increase in high density lipoprotein-cholesterol and significantly greater decreases in low density lipoprotein-cholesterol, apolipo-protein B, lipoprotein(a) and high-sensitivity C-reactive protein occurred in the study group compared with the control group over the 3-month study period. Paraoxonase and arylesterase activities, and flow- and nitroglycerine-mediated dilatation of the brachial artery showed significantly greater increases in the study group compared with the changes in the control group. In conclusion, consumption of Origanum onites distillate had beneficial effects on lipid profiles, antioxidant status and endothelial function in patients with mild hyperlipidaemia.

Cystadenoma originating from the gallbladder.

Biliary cystadenomas are very uncommon benign tumors. They are very rare occurrences in the gallbladder, and there are only a few case reports in the literature. 1-3 Cystadenomas are more frequently seen among middle-aged women. The clinical presentation varies and depends on the size and location of the cyst. They are unilocular or multilocular cystic tumors that contain septations. Although biliary cystadenomas are of a benign nature, they may recur after excision, and there is a risk of development of cystadenosarcomas. 4-6 Hepatobiliary cystadenomas are most commonly seen in the liver (83%) followed by the extrahepatic biliary system (13%) and gallbladder (0.02%). 7 In this report, we present the sonographic results of a rare case of cystadenoma originating in the gallbladder.

Effects of fat accumulation in the liver on hemodynamic variables assessed by doppler ultrasonography

To investigate the effect of various degrees of fatty liver infiltration on hepatic hemodynamics using Doppler ultrasonography.

Secondary aortoenteric fistula in a patient with Behçet disease: successful surgical treatment by direct suture and use of omental flap.

The aim of this report is to present a patient with Behçet disease who developed massive lower gastrointestinal tract bleeding owing to aortoenteric fistula after abdominal aorta graft reconstruction. A 34-year-old male with a history of Behçet disease for 8 months underwent surgery owing to massive hematochezia and hemodynamic instability. A fistula was observed between the proximal small intestinal segment and the aortic graft (proximal anastomosis) at the infrarenal level. The prosthesis was not removed but was wrapped with the vascularized pedicle of the omentum that passed through the mesentery of the transverse colon. The patient was discharged on the fifty-ninth day. At the 15-month follow-up appointment, the patient was in excellent condition. Although our surgical choice was not a standard approach for this type of aortoenteric fistula, it was a lifesaving procedure in our patient.

Castleman's Disease: Unilateral Cervical Involvement and Imaging Findings A Case Report

Castlemans disease is an idiopathic lymphoproliferative disorder characterized by massive enlargement of lymph nodes. It may have a unifocal or multifocal presentation; the mediastinum is the most common site (70%). Patients with cervical disease usually have unifocal involvement (90%). The main problem posed by cervical Castlemans disease is that it should be considered in the differential diagnosis of cervical tumors. This report describes a patient who had unifocal Castlemans disease on the left side of the neck, and discusses the differential diagnosis with findings on magnetic resonance imaging, computed tomography and ultrasonography.

Authors' reply: Giant spigelian hernia due to abdominal wall injury: a case report (Hernia (2006) 11:67-69)

To the Editors, We thank LosanoV and Basson for their critique of our case report. First of all, we wish to emphasize that our paper was not a review article; it was only a case report. The size that a Spigelian hernia (SH) needs to be before it can be termed “giant” is yet to be deWned in the English literature. Furthermore, a 10-cm-diameter muscular defect is very large for this kind of hernia. We presented only the diameter of the hernia neck, because it was a stable measurement; the clinical size of the hernia was actually much more than this. The authors doubt whether our case was a SH. Our patient did not show any history of SH before the trauma. Some post-traumatic SHs like ours have been reported in the literature previously, however [1, 2]. We agree with the authors’ skepticism regarding whether this kind of hernia should be called a SH or post-traumatic hernia. Abdominal trauma can suddenly increase the intraabdominal pressure and cause SH [3]. The term “Spigelian hernia” does not just refer to a type of hernia; the term also describes the location of the hernia. Therefore, it is diYcult to state that such a hernia that presents after trauma is not a SH. We used nonabsorbable multiWlament mesh in this case. The infection rate in abdominal wall reconstruction with mesh, for clean surgeries, is 1–2% of all grafts. Engelsman et al. [4] stated that multiWlament meshes have a higher infection rate in their review article. However, there was no reference that included a clinical study of this issue in their article. We think that bacterial contamination during surgery is the main factor in this rate. In one randomized clinical study, the recurrence rates for diVerent types of meshes used in hernia repair were not found to be signiWcantly diVerent [5]. Again, there is no published randomized controlled clinical trial in the English literature that reports that sublay or intermuscular mesh placement is better than onlay placement. We agree with LosanoV and Basson that laparoscopic SH repair is an alternative to the open technique. The open technique was our patient’s preference. Furthermore, laparoscopic hernia repair is more expensive than the open technique in our country. On the other hand, the recurrence rate is lower when the open technique is used in inguinal hernia repair rather than the laparoscopic technique, according to a study published recently [6].