Nuri Karabay

Screw prominences related to palmar locking plating of distal radius

Fixation of unstable distal radius fractures with palmar locking plates provides a stable reduction and early return of function, but complications arising from unrecognized dorsally prominent screws penetrating the extensor compartments are increasingly reported. Standard radiographs and fluoroscopy may not adequately visualize screw lengths, owing to the complex shape of the dorsum of the distal radius. We examined 46 distal radius fractures treated with palmar locking plates by ultrasound. Of the total 230 locking screws, 59 protruded from the dorsal cortical surface by 0.5 mm or more (range 0.5–6.1 mm). The first extensor compartment was violated by one screw, the second compartment by 22 screws, the third compartment by 15 screws, and the fourth compartment by 21 screws. Asymptomatic tenosynovitis was detected in four and symptomatic tenosynovitis in 14 of the 59 prominent screws. Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex.

Various radiological appearances of angiomyolipoinas in the same kidney

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma with minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discused.

Transient neonatal hypoglycemia: cranial US and MRI findings

A case of transient neonatal hypoglycemia with patchy hyperechogenic white matter abnormalities in the frontal and parietooccipital lobes on cranial US is presented. An MRI examination revealed T1 and T2 shortening of the lesions in the occipital and frontal white matter. Follow-up cranial US demonstrated recovery of white matter changes in the patient with normal neurological outcome.

Increased hippocampal volumes in lithium treated adolescents with bipolar disorders: A structural MRI study

BACKGROUND Structural neuroimaging studies in bipolar disorder (BD) have consistently identified several anatomical abnormalities in many brain areas related to mood regulation. Hippocampus is one of the key components of emotional regulatory networks in the brain. Evidence about hippocampal changes in BD is quite limited and inconsistent particularly for adolescent onset BD. It is aimed to compare hippocampus volumes of euthymic BD-I adolescents with healthy controls using structural MRI. METHODS Hippocampal volumes of seventeen youths between 13 and 19 age period with DSM-IV BD (seven boys) and twelve healthy comparison subjects (five boys) were compared using structural MRI. Differences in hippocampal volumes between groups were tested. RESULTS There was no significant difference between the right and left hippocampus volumes of patients with BD and the control group. However boys tended to have significantly larger right hippocampal volumes than girls both in BD and control group. Right hippocampal volumes were enlarged in lithium treated bipolar patients. This enlargement is not related to sex. LIMITATIONS Future, longitudinal follow-up studies need large enough sample sizes of both sexes and a sex-matched healthy comparison group to sort out developmental, gender and medication influences on brain structures over time in BD. CONCLUSIONS Lithium treatment in adolescent-onset BD has a significant effect on hippocampus volumes.

Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity

The aim of our study is to assess the efficiency of the ultrasonography (US) in the diagnosis of peripheral nerve injury. This study includes nine patients (six radial, one median and two posterior interosseous (PIO) nerves) with peripheral nerve injury diagnosed by clinical and electrophysiological methods in the last 3 years. Preoperatively, an ultrasonographic examination was performed and correlated with physical exam and surgical findings. Five patients, who were diagnosed as peripheral nerve transection by US, underwent surgery. The ultrasonographic findings were concordant with the intraoperative findings. Axonal swelling alone was found in the remaining three patients, who were treated conservatively because of preserved nerve continuity without display of nerve compression. In one patient, we were unable to visualize the nerve due to obesity and soft tissue edema. High-resolution US provide morphological information about the exact location, intensity and extent of the nerve injuries, facilitating the preoperative diagnosis. Thus, US may be a useful method for planning optimal treatment strategy in especially iatrogenic nerve injuries.

Decreased Right Hippocampal Volumes and Neuroprogression Markers in Adolescents with Bipolar Disorder

Objectives: The aim of the present study was to assess differences and correlations between the hippocampal volumes (HCVs), serum nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) levels in adolescents with bipolar disorder (BP) compared to healthy controls. Methods: Using structural magnetic resonance imaging, we compared HCVs of 30 patients with euthymic BP who were already enrolled in a naturalistic clinical follow-up. For comparison, we enrolled 23 healthy controls between the ages of 13 and 19. The boundaries of the hippocampus were outlined manually. The BDNF and NGF serum levels were measured with the sandwich ELISA. Results: The groups did not differ in the right or left HCVs or in the NGF or BDNF serum levels. However, negative correlations were found between the right HCVs and the duration of the disorder and medication and positive correlations were found between the duration of the medications and the NGF and BDNF levels in the patient group. Additionally, positive correlations were found between the follow-up period and left normalized HCVs in both the BP and lithium-treated groups. Conclusions: The right HCVs may vary with illness duration and the medication used to treat BP; NGF and BDNF levels may be affected by long-term usage. Further research is needed to determine whether these variables and their structural correlates are associated with clinical or functional differences between adolescents with BP and healthy controls.

Validity of ultrasonography in surgically treated zone 2 flexor tendon injuries

OBJECTIVES The purpose of this study was to determine the validity of ultrasonography (USG) with surgical confirmation in surgically treated zone 2 flexor tendon injuries. METHODS Between 2003 and 2008, zone 2 flexor tendon repairs of 30 patients were evaluated with real-time USG when there was a loss of motion and prediagnosis of rupture or adherence in follow-up. The mean duration between injury and USG evaluation was 81.5 days (range 10-240 days). USG demonstrated rupture in 15 patients, adherence in 14 patients, and tenosynovitis in one patient. After clinical examination, surgery was performed in 27 of the patients. RESULTS Fifteen patients with diagnosis of rupture in USG were operated, and diagnosis was confirmed in 14 patients. Eleven patients in the adherence group were also surgically treated. Eight of them received only tenolysis, and three were repaired with tendon grafts-one for rerupture and two for insufficiency after tenolysis. One patient who was diagnosed with tenosynovitis also had a re-ruptured tendon. Therefore, USG resulted in one false finding out of the 15 patients in the rupture group, one false finding out of 11 patients in the adherence group, and one false finding in tenosynovitis group. In total, validity of USG was confirmed in 24 of 27 patients. CONCLUSION USG is a dependable diagnostic aid in operated zone 2 flexor tendon injuries when there is uncertainty of rupture or adherence.

US findings in traumatic wrist and hand injuries

Traumatic injuries of the wrist and hand are common. Ultrasonography (US) is a cost-effective, noninvasive, and effective imaging method for diagnosing traumatic lesions affecting the tendons, annular pulleys, ligaments, vessels, and nerves, and for detecting foreign bodies in the wrist and hand. The objective of this article was to review the main US findings of traumatic lesions in the wrist and hand.

Surveillance imaging and cost effectivity in pediatric brain tumors

OBJECTIVE The purpose of this study was to determine the role and cost effectiveness of surveillance imaging at the management of pediatric brain tumors. MATERIALS AND METHODS In this study, the imaging and clinical finding of 59 patients who had been diagnosed and followed by the Dokuz Eylul University Pediatric Oncology Group as primary central nervous system tumors between 1988 and 2000 were retrospectively evaluated. RESULTS We found that the 87.5% of tumor recurrence occurs within 21 months and 93.8% occur within 29 months. About 25% of these recurrences were asymptomatic and these (n=16) could be detected by surveillance imaging with a frequency rate of 1.59%. The cost of imaging for our patients was calculated to be 788 US

Sonographic and MRI findings in prepubertal adnexal hemorrhagic cyst with torsion

(mean) for a follow-up period of 24 months which would have been 739 US