Sema Bulut

The efficacy of ultrasonography in hemodynamically stable children with blunt abdominal trauma: a prospective comparison with computed tomography.

PURPOSE In this prospective study we aimed to investigate the diagnostic value of ultrasonography (US) in hemodynamically stable children after blunt abdominal trauma (BAT) using computed tomography (CT) as the gold standard. MATERIALS AND METHODS Between 1997 and 2001, 96 children with BAT were evaluated prospectively. CT was performed first, followed by US. US and CT examinations were independently evaluated by two radiologists for free fluid and organ injury. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US were assessed regarding CT as the gold standard. RESULTS Overall 128 organ injuries were determined in 96 patients with CT; however, 20 (15.6%) of them could not be seen with US. Free intraabdominal fluid (FIF) was seen in 82 of 96 patients by CT (85.4%) and eight of them (9.7%) could not be seen by US. We found that sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of the US for free intra-abdominal fluid were 90.2, 100, 100, 63.6 and 91.7%, respectively. CONCLUSIONS US for BAT in children is highly accurate and specific. It is highly sensitive in detecting liver, spleen and kidney injuries whereas its sensitivity is moderate for the detection of gastrointestinal tract (GIT) and pancreatic injuries.

Lipoma arborescens; successfully treated by yttrium-90 radiosynovectomy

Although radiosynovectomy (RS) applications have been carried out for many years, clinical indications of this non-invasive procedure is though to be limited probably due to the lack of information of clinicians. Clinicians’ preferential indication for RS is the treatment-resistant synovitis of individual joints, i.e. despite systemic pharmacotherapy and intra-articular steroid injections. We present here a case of “lipoma arborescens” treated by yttrium-90, which is a rare intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of subsynovial fat. The results of clinical, biochemical and hematological examinations, magnetic resonance (MR) imaging, arthroscopy and histological analysis have shown that the etiology was lipoma arborescens in a female patient, aged 36 having swelling and sometimes associating pain at her right knee for 4 years. We have applied to our patient’s right knee RS with 185 MBq yttrium-90 colloid together with 40 mg of methylprednisolone acetate, although in our literature survey we have not met any similar case being treated with such indication. Even a year after the application, the patient has absolutely benefited from the treatment clinically, and this was also confirmed by comparative MR images (pre- and post-treatment). Consequently, we consider that Y-90 treatment might be applicable in suitable cases with lipoma arborescens.

The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience.

Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. Results: PCN procedures were performed via 1–3 punctures in patients with grades 0–1 and 2 hydronephrosis, and via 1–2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0–1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis.

Evaluation of pulmonary changes due to biomass fuels using high-resolution computed tomography

Abstract.Biomass fuels are frequently used in rural areas of the world for cooking and heating frequently. It has been reported that the use of these fuels causes hazardous effects on the lungs. In this study, we evaluated the pulmonary changes due to the use of biomass fuels in a female population that lives in our territory by high-resolution computed tomography (HRCT). The study analyzed three groups of women. The first group comprised those subjects who were exposed to biomass without respiratory symptoms (group 1; n=32). The second group comprised those individuals that were exposed to biomass and showed respiratory symptoms, such as cough, sputum production, and dyspnea (group 2; n=30). The third group was composed of women who were not exposed to biomass and also had no respiratory symptoms (group 3; n=30). Women with a history of concomitant pulmonary diseases were excluded from the study. All groups were examined with HRCT. Groups 1 and 2 (individuals exposed to biomass fuels) had more pathologic findings than group 3 (not exposed to biomass fuels). Ground-glass appearance was seen in 71.9% in group 1, 23.3% in group 2, and 3.3% in group 3. The difference between the groups was statistically significant (p<0.05). Fibrotic bands were seen 50% in group 1, 63.3% in group 2, and only 6.7% in group 3 (p<0.001). Exposure to biomass fuels was the cause or predisposing factor for many pulmonary diseases, ranging from chronic bronchitis to diffuse lung diseases. We believe that these pathological changes due to biomass fuels can be detected earlier by HRCT and the diseases might be prevented or treated earlier.

Normal thyroid volume by ultrasonography in healthy children.

Abstract With the objective of creating standards for the volume of the thyroid gland by ultrasonography in the 0-16-year age group, thyroid volumes of 302 healthy children (150 boys, 152 girls) were measured by ultrasonography. The transverse (x), sagittal (y) and anteroposterior (z) lengths of the right and left lobes and isthmus were measured. Volumes of these were calculated by the ellipsoid volume formula [V=(π/6)×x×y×z]. Statistical analysis was done using the Kruskal-Wallis and Student t tests. The cases were divided into six and eight groups by age and height, respectively. There was a significant positive corelation between thyroid volume, age, height and weight. Thyroid volumes in children of 12 years and over were significantly different from those in the younger age groups.

Extracorporeal shock wave treatment for defective nonunion of the radius: a rabbit model.

Purpose. To investigate the effect of extracorporeal shock wave treatment (ESWT) on bony union using volume analysis of the callus mass by computed tomography and histology. Methods. Both radii of 13 rabbits were osteotomised and a defective bony nonunion created by placing a polyethylene pad between the osteotomy site for 40 days. Nonunion was confirmed by radiography using Lane-Sandhu criteria. ESWT (14 kW, 0.46 mJ/mm2, 1000 shock waves) was applied to the right radius of the rabbits. The left radius served as a control. Five rabbits were killed 4 weeks after ESWT (group 1) and 8 after 6 weeks (group 2). Volume analysis of the callus mass was performed using computed tomography and the bone healing process was assessed by histology. Results. In group 1, callus volume on the treated side was invariably greater than that on the control side; the difference being statistically significant (p=0.032). In group 2, the callus volume of the treated side was greater than that of the control side, except in rabbits 4 and 9. Only after excluding the findings from the latter did the difference attain statistical significance (p=0.020). Histology confirmed that the bone-healing process was faster in the treated side. Conclusion. ESWT enhanced the bone-healing process by increasing both volume and speed of callus formation.

The measurement of the rotational deformities with computed tomography in femoral shaft fractures of the children treated with early spica cast

Twenty-eight children with femoral shaft fractures, treated with early spica cast, were evaluated with computed tomography (CT), for their femoral shaft rotational deformities. The femoral torsion angles were measured on both sides. If the torsion angle of the fractured side was more than the other side, it was considered as an internal rotational deformity and if it was less, it was considered as an external rotational deformity. Internal rotational deformities were detected in nine cases and external rotational deformities were detected in 17 cases. Rotational deformity was not observed in two cases. Four cases, with a rotational deformity more than 10 degrees, were corrected with a gypsotomy through the level of the fracture. We concluded that a rotational deformity, which is an important complication in conservative treatment of the femoral shaft fractures in children, can be determined exactly with CT and corrections on the spica cast can be made with a gypsotomy.

Magnetic resonance spectroscopy and diffusion-weighted imaging findings in a child with Leigh's disease.

Leigh’s syndrome is a rare inherited metabolic neurodegenerative disease due to a mitochondrial enzyme deficiency that can potentially occur in any site of the enzyme pathway for respiratory metabolism. The disease usually affects infants and children; adult onset cases have been described occasionally. Leigh’s disease usually has involvement of the periaqueductal gray matter, the basal ganglia (particularly the putamina) and the white matter. 1,2 We present a 4-year-old girl with this disorder.

Evaluation of the prevertebral soft tissue thickness by magnetic resonance imaging in patients with mild neck problem.

AIM We encountered no study conducted on the evaluation of prevertebral soft tissue (PVST) thickness by magnetic resonance imaging (MRI) during our literature search. Measuring PVST thickness by MRI in the cervical region of adult cases was aimed in the present retrospective study. MATERIAL AND METHODS For the intended purpose, a total of 136 patients, composed of both males and females, with ages ranging from 20 to 69 years, in whom no pathology in the cervical prevertebral region was revealed by MRI modality implemented for various reasons, were included in the study. RESULTS The upper limit of normal for PVST thickness was measured in our study to be 10 mm, 7 mm and 20 mm at C1, C2-C3 and C6-C7 vertebral levels, respectively. The least variation in the measurements and standard deviations were obtained at C3-C4 vertebral levels. Upon making a comparison between the measured PVST thicknesses on the basis of gender, the measurements at C2,C4 and C7 were found to display significant difference, whereas that was not the case for the measurements obtained at the other levels. CONCLUSION Progressively widespread use of MRI for the traumas inflicting the cervical region makes it obligatory to specify normal values for the thickness of PVST measured by MRI.

Waardenburg syndrome type I and small patella syndrome in the same patient

lateral dystopia canthorum, abnormal pigmentation (heterochromia irides, white forelock and/or hypopigmented macules on the skin), broad nasal root, synophrys and sensorineural deafness.1–6 However, the clinical features are variable and these stigmata may be present in any combination and degree. Major manifestations of small patella syndrome (SPS) are hypoplasia of patellae and pelvic dysplasia.1,3,7,8 The mode of inheritance of both syndromes is autosomal dominant.3 In the present paper, we report a very interesting case in whom both syndromes, WSI and SPS, were observed.