Senay Demir

Response of infantile hepatic hemangioma to propranolol resistant to high-dose methylprednisolone and interferon-α therapy.

To the Editor: Infantile hepatic hemangioma (IHH) is a liver tumor commonly seen in infants under 6 months. Most of them are asymptomatic, being found incidentally during abdominal imaging. Spontaneous regression after 18–24 months is commonly observed. IHH may also be complicated by cardiac failure, hepatic dysfunction, tumor rupture, and abdominal compartment syndrome. In these cases, the mortality rate is high, despite a variety of comprehensive treatments [1,2]. A 7-month-old male, receiving prednisolone and interferonfor 3 months as treatment for an IHH, was sent to our clinic for further treatment considerations. During admission he had excessive abdominal distension causing respiratory distress because of a large liver. There were two cutaneous hemangiomas and six café au lait spots larger than 1.5 cm in diameter. Laboratory tests showed no abnormality. On MRI, multiple nodular lesions comprising all of the liver were seen suggesting infantile hemangioendothelioma (Fig. 1A). Tru-cut biopsy was performed and the histopathology confirmed the diagnosis. According to current diagnostic standards it was diagnosed as diffuse IHH [2]. As the disease was resistant to the previous therapy, we started vincristine. After 2 weeks, the abdominal distension and respiratory distress had increased. A second course of high-dose methylprednisolone was given and the vincristine dose was increased from 0.04 to 0.065 mg/kg/week. Treatment with prednisolone and vincristine was continued for 10 weeks and the abdominal circumference decreased from 53 to 50 cm. Abdominal MRI showed an increased in size of the largest lesion (45–55 mm), but the number and size of

Factors Associated With the Thickness of the Ligamentum Flavum: Is Ligamentum Flavum Thickening Due to Hypertrophy or Buckling?

Study Design. Ligamentum flavum (LF) thickness was measured by using lumbar magnetic resonance imaging in patients with low back or leg pain. Objective. This study investigated whether LF thickening is due to hypertrophy or buckling related to disc degeneration and examined the correlations between the thickness of the LF and age, sex, body mass index (BMI), degree of pain, lumbar spinal stenosis (LSS), and disc herniation. Summary of Background Data. “LF thickness” and “LF hypertrophy” are used interchangeably in the literature, although they are not necessarily the same thing. Thickness may increase by buckling without a change in the mass of the LF, and whether LF thickening is due to tissue hypertrophy or buckling remains controversial. Methods. The thickness of 896 LFs at the L2–L3, L3–L4, L4–L5, and L5–S1 levels of 224 (mean age, 47.8 ± 16.7 yrs) patients was measured prospectively on axial T1-weighed magnetic resonance images, obtained at the facet joint level. The presence of disc degeneration, spinal stenosis, and disc herniation was evaluated. Results. At all of the levels investigated, LF thickness was significantly greater in patients with grades IV to V degeneration compared with the patients with grades I to III degeneration (P < 0.05). LF thickness at all levels increased significantly with age (P < 0.05). Sex and the degree of pain were not correlated with the thickness of the LF. Patients with a BMI of 25 kg/m2 or greater had the thickest LF at the L3–L4 level (P < 0.01). LF thickness was significantly greater at the L2–L3, L3–L4, and L4–L5 levels in subjects with LSS and significantly greater at all levels in subjects with disc herniation (P < 0.05). Conclusion. Thickening of the LF is correlated with disc degeneration, aging, BMI, LSS, spinal level, and disc herniation. The authors concluded that thickening of the LF is due to buckling of the LF into the spinal canal secondary to disc degeneration more than to LF hypertrophy. Sex and the degree of pain were not correlated with the thickness of the LF.

Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl

Primary vaginal stones are extremely rare in children and may be mistaken for bladder calculi on plain radiography. We present a case of a large vaginal calculus in a 6-year-old girl who had an imperforate hymen and urethrovaginal fistula. Hymenotomy and urethrovaginal fistula repair were performed, and the vaginal stone was extracted. It was postulated that the vaginal calculus originated from stasis of urine through the urethrovaginal fistula in the obstructed vagina. This is a unique case of a vaginal calculus with a congenital urethrovaginal fistula associated with an imperforate hymen.

Metastatic Pulmonary Calcification in a Patient with Chronic Renal Failure

Metastatic pulmonary calcification characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. We present a case of a 47-year-old man with chronic renal failure presented with dyspnea, high-resolution computed tomography of the chest revealed multiple, centrilobular, calcified nodules and patchy areas of ground-glass opacity throughout both lungs, consistent with metastatic pulmonary calcification. Calcification was also seen in the bronchi and trachea.

Prenatal Diagnosis of a Mass in the Adrenal Region That Proved to be a Teratoma

A prenatally detected suprarenal cystic mass measuring 2 cm was found to have enlarged upon postnatal ultrasonography at 6 weeks of age. Magnetic resonance imaging showed a 57 x 50 mm mass in the left adrenal region displacing the kidney inferiorly. The infant underwent an adrenalectomy with total resection of the tumor, which proved on histologic examination to be a mature teratoma. Prenatally detected suprarenal masses are likely to be neuroblastoma or adrenal hemorrhage, but may be rare benign lesions such as extralobar pulmonary sequestration, bronchogenic cyst, or renal dysplasia. Although teratoma in the adrenal region is extremely rare, it should be included in the clinical and radiologic differential diagnosis of prenatally detected suprarenal masses. Total excision of the mass for histologic diagnosis is indicated.

Ergotamine-induced lower extremity arterial vasospasm presenting as acute limb ischemia.

Ergotamine-induced limb ischemia is rare and usually results from an accidental overdose. Several agents, including erythromycin and tetracycline, raise serum ergotamine levels and augment its effect. We present a case of acute lower limb ischemia with characteristic angiography findings of diffuse arterial spasm resulting from use of ergotamine and an erythromycin derivative, clarithromycin. The history of the patient and classic features seen on angiography helped us establish the diagnosis. The patient was successfully treated with low molecular heparin and epidural infusion of bupivacain. Since ergot vasospasm is a self limited and medically treatable condition, interventional radiologists must be aware of ergotamine-induced acute limb ischemia to avoid any unnecessary interventional procedures, unless necrosis and gangrene are imminent.

Effects of respiratory manoeuvres on hepatic vein Doppler waveform and flow velocities in a healthy population

OBJECTIVE This study was performed to determine the variations in Doppler waveforms and flow velocity during respiratory manoeuvres in healthy individuals with no liver disease. MATERIALS AND METHODS In total, 100 individuals (75 women and 25 men) without known cardiac or liver disease were examined prospectively with duplex Doppler ultrasonography (US). We recorded the Doppler waveforms and peak systolic velocities (V(max)) of the middle hepatic vein during normal respiration, during breath-holding after quiet expiration and also during deep inspiration. Doppler waveforms are categorised as triphasic, biphasic or monophasic. RESULTS During normal respiration, hepatic venous waveforms were triphasic in 93% of subjects, monophasic in 6% and biphasic in 1%. During breath-holding after quiet expiration, the percentages were 91%, 6% and 3%, respectively. During deep inspiration, they were 80%, 18% and 2%, respectively. Although significant differences were noted between rates during deep inspiration and normal respiration, they were quite similar during normal respiration and breath-holding after quiet expiration (P<0.05). The values of V(max) were significantly higher during normal respiration compared to quiet expiration and during quiet expiration compared to deep inspiration (P<0.05). CONCLUSION The velocities and waveforms of hepatic veins varied during respiratory manoeuvres. The status of respiration must be taken into consideration whilst examining the hepatic vein waveforms and velocities with duplex Doppler US.

A different cause for respiratory disorder in children: cases with pulmonary Langerhans cell histiocytosis

In children, complaints of a respiratory disorder are very frequent. Etiology of respiratory illness is a broad spectrum that varies from a simple viral infection to a malignant disorder. Pulmonary Langerhans cell histiocytosis (PLCH) is one of these entities and it is truly rare in children. The aim of this study is to evaluate our patients with PLCH.

Intestinal malrotation needs immediate consideration and investigation

The aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation.

Value of sonographic anterior-posterior renal pelvis measurements before and after voiding for predicting vesicoureteral reflux in children.

Voiding cystourethrography (VCUG) is the gold standard for diagnosing vesicoureteral reflux (VUR), but it is important to minimize the use of VCUG because of the urinary catheterization and radiation exposure required. Ultrasound (US) observations suggest that pelvicalyceal dilatation varies according to the degree of bladder fullness in children with urinary tract infection. The aim of this study was to assess whether anterior‐posterior (AP) measurements of the renal pelvis on US before and after voiding can be used as a screening tool while predicting the presence of VUR in children.