Sadi Gundogdu

MRCP vs ERCP in the evaluation of biliary pathologies: Review of current literature

OBJECTIVE:  Recently developed magnetic resonance (MR) techniques permit fast and correct imaging of the entire biliary tree with a high spatial resolution. The aim of this study was to compare the diagnostic potential of one of these new MR sequences in magnetic resonance cholangiopancreatography (MRCP) procedure and endoscopic retrograde cholangiopancreatography (ERCP) with review of current literatures.

Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

BackgroundCephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).ObjectiveTo evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity.Materials and methodsThe study population consisted of 39 children, aged 4–12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded.ResultsCranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=−0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH (P<0.001).ConclusionsThere is significant correlation between cephalometric data and AHI score severity in children with OSAS. Adenotonsillar hypertrophy affects the cephalometric measurements adversely. The study clearly mandates the institution of early and effective therapy of adenotonsillar hypertrophy in children with OSAS.

Assessment of image quality of a standard and three dose-reducing protocols in adult cranial CT

The purpose of this study was to analyze the effect of various tube current settings (mAs) and optimize the image quality and dose for adult cranial CT protocol. Sixty adult patients who underwent a cranial CT scanning for different indications were subdivided into three subgroups. Subjective image and noise quality scores and quantitative noise measurements were selectively studied on three reference levels (cerebellar, basal ganglia and centrum semiovale levels). For each subgroup, only one level was studied. Head circumference (HC) and the maximum anteroposterior diameter (MAPD) of each patient were measured. At 50% decreased dose protocol, there was no poor quality score at any level. At nearly 60% decreased dose protocol, the incidence of poor quality scores was much higher at the cerebellar level than at the other two levels. For the same protocol number, quantitative noise measurements were higher at the cerebellar level than the other two supratentorial levels. The correlation was found to be significant between HC, MAPD and quantitative noise measurements, and there was a non-significant correlation between HC and subjective noise scores. In adult cranial CT, depending on the level, a dose reduction of up to 60% may be possible while maintaining image quality.

Enlargement of the bone component in different parts of compensatorily hypertrophied inferior turbinate.

Background To evaluate the unilateral compensatorily hypertrophied inferior turbinate (CHIT) by computed tomography (CT) and determine the enlargement of the bone component in different parts of the CHIT. Methods Patients were studied in three groups: those with a straight or nearly straight septum (n = 143), with mild deviation (n = 42), and with moderate to severe deviation (n = 99). The cross sectional area (CSA) of the inferior turbinate (IT) bone and the whole turbinate were measured at anterior, middle, and posterior thirds of the IT in coronal sections. The ratio of CSA of the IT bone on two sides of the septum (interturbinate ratio) and the ratio of the CSA of the overall turbinate to the IT bone (intraturbinate ratio) were calculated. Results The interturbinate ratio of the bony turbinate CSA for the severe deviation group was significantly higher compared with other groups in anterior and middle segments (p < 0.0001). The intraturbinate ratio was highest in the posterior segment and lowest in the middle segments in compensatorily hypertrophied sides for all groups (p < 0.001). Conclusion Skeletal enlargement is prominent in anterior and middle thirds of CHIT in patients with pronounced septal deviation.

Mucinous cystadenoma mimicking simple renal parenchymal cyst in a horseshoe kidney

Abstract  We report a case of mucinous cystadenoma in a horseshoe kidney which radiologically resembled a simple renal cyst. In the published literature, three cases of mucinous cystadenoma of renal origin have been reported. Although these tumors are believed to originate from the renal pelvis, the cyst in the present case originated from renal parenchyma. The significance of this particular case is the radiological features, which mimick a simple renal parenchymal cyst and contribute to the histopathological definition of an extremely rare disease.

Ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge

Ceftriaxone is known to induce precipitates that mimic a gallstone on sonograms in the gallbladder of children and adults. Terms such as ‘biliary pseudolithiasis’ are now used to denote the reversible, benign character of this complication upon discontinuation of ceftriaxone therapy. 1–3 The first sonographic demonstration of precipitates forming in the gallbladder during ceftriaxone therapy was reported by Schaad et al . in 1986. 3 In subsequent reports, biliary sludge or biliary pseudolithiasis, has frequently been reported with this antibiotic. 1,2,4 Ceftriaxone-induced urinary calculi are rarely observed. Six cases of ceftriaxone urinary calculi have been published. 1,4–7 In this study, we report a case who developed ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge, which were completely resolved after the ceftriaxone treatment ceased. To our knowledge ceftriaxone-induced urinary bladder sludge has not been reported previously. In this case, we report the first documented case of ceftriaxone-induced urinary bladder sludge.

Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study

Abstract The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20–30-minute periods, for 5–14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4–9 days of ceftriaxone therapy, and resolved completely 7–19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.

The Value of Scintimammography in Reduction Mammaplasties: A Preliminary Study

Reduction mammaplasty results in architectural distortion, fat necrosis, and heavy scarring of the breast. In such conditions, mammography (MG) might not be reliable and an alternative unfailing imaging technique is demanded to prevent unnecessary apprehension and biopsy. With this study, the value of Tc-99m sestamibi (MIBI) scintimammography (SCM) as an adjunct test after reduction mammaplasty was explored. MIBI scintigraphy is not affected by scar tissue or breast density and is able to differentiate benign and malignant lesions. The study was conducted on 12 women undergoing a reduction mammaplasty operation (McKissock technique). The average age was 38 and the average weight of breast tissue removed from each breast was 320 g. All patients, except one who was 21 years old, underwent MG and SCM preoperatively, and these tests were repeated at the sixth postoperative month. Preoperative MG and SCM revealed no pathology except a finding in one patient consistent with fibroadenoma. Postoperatively, the most common findings in MG were parenchymal redistribution, elevation of the nipple, and retroareolar fibrotic bands. Calcifications and oil cysts were not seen. Other findings were areola and skin thickening. Interestingly, these findings were not evident on the SCM, in fact it was not possible to state whether or not the breast had been operated on. In conclusion, SCM may not be used as screening test, but it should be considered when the postoperative MG is not informative or is complicated by scaring. In this condition, SCM may be used as a complementary method to MG and may help to prevent unnecessary breast biopsies.

Echinococcosis involving the liver, retrovesical and seminal vesicle presented with syncope

Abstract  Hydatid disease of the urogenital system, especially of the retroperitoneum and seminal vesicles, is a very rare condition. We report a case of hydatid disease located in the liver, retrovesical region and seminal vesicle that was diagnosed incidentally while investigating the etiology of syncope. Transabdominal and transrectal ultrasonography revealed hypoecoic multicystic masses which had thin septations and walls in the liver, retrovesical region and seminal vesicle. Abdominal computed tomography examination showed multicystic low attenuation masses in the same region. Pelvic magnetic resonance image findings revealed multiple cystic masses in the retrovesical region and the right seminal vesicle. In conclusion, the diagnosis of hydatid disease should be kept in mind with patients who have cystic lesions in seminal vesicle and retrovesical region.

The benefit of expiratory-phase quantitative CT densitometry in the early diagnosis of chronic obstructive pulmonary disease.

PURPOSE We aimed to compare the inspiratory and expiratory quantitative computed tomography (CT) densitometric data of healthy volunteers, individuals with chronic obstructive pulmonary disease (COPD) risk, and COPD patients to aid in the early diagnosis of COPD. MATERIALS AND METHODS Of the study patients, 14 were healthy volunteers (Group I), 12 were patients at risk for COPD (Group II), and 13 were COPD patients (Group III). The high-resolution CT was performed at three levels (the upper, middle, and lower parts of the lungs). All images were evaluated with a specific program for the segmentation of pulmonary parenchyma. The mean lung density (MLD) was measured, and the emphysema index (EI) was calculated using this program. RESULTS Both MLD values and calculated EI ratios showed significant differences between Groups I and III, and Groups II and III in both expiratory and inspiratory phases (P < 0.05). However, in the comparison of healthy volunteers and patients at risk for COPD (Group I and II), only expiratory-phase MLD values showed statistically significant difference (P < 0.001). CONCLUSION In patients at risk for COPD, expiratory-phase MLD measurements can be used as an early diagnostic method.