Serap Dogan

Effect of long-term and high-dose allopurinol therapy on endothelial function in normotensive diabetic patients

Abstract Objectives. Endothelial dysfunction is a well known risk factor for atherosclerosis. Uric acid levels are associated with endothelial dysfunction and atherosclerosis even if in physiological range. Xanthine oxidase inhibition with allopurinol decreases uric acid levels and oxidative stress and improves endothelial function. We have investigated the effect of high-dose and long-term allopurinol therapy on endothelial function in diabetic normotensive patients. Methods. This study is a randomized, single-blind, placebo-controlled trial. Both treatment and placebo groups consisted of 50 patients. In the treatment group, daily oral 900 mg allopurinol was started after randomization and maintained for 12 weeks. Brachial artery flow-mediated dilatation (FMD) and nitrate-induced dilatation (NID) were measured at baseline and after the allopurinol therapy to evaluate endothelial function. Results. HbA1c and uric acid levels decreased after allopurinol therapy (6.1 ± 2.1 vs 5.5 ± 1.0%, 5.0 ± 0.8 vs 3.3 ± 0.5 mg/dl, respectively, p = 0.01) but no change was observed in the placebo group (7.7 ± 1.9% vs 7.6 ± 2.0%, 5.3±2.1 vs 5.6 ± 0.8 mg/dl, respectively, p > 0.05). FMD and NID increased significantly in the treatment group (5.6 ± 2.1% vs 8.5 ± 1.2%, 10 ± 7.4% vs 14 ± 4.0%, 10 ± 7.4% vs 14 ± 4.0%, respectively, p = 0.01), whereas no change was observed in the placebo group (5.8 ± 1.8% vs 6.1 ± 0.8%, 12 ± 9.5 vs 10 ± 3.8%, respectively, p > 0.05). Conclusion. Long-term and high-dose allopurinol therapy significantly improved endothelial function in diabetic normotensive patients. In addition, allopurinol therapy contributes to the lower HbA1c levels.

Congenital thoracic arterial anomalies in adults: a CT overview.

Congenital thoracic arterial anomalies can be incidentally detected in adults from imaging studies performed for other indications. Multidetector computed tomography plays a critical role in the noninvasive assessment of these anomalies and associated cardiac, mediastinal, or parencyhmal changes by providing volumetric data. Radiologists should be familiar with imaging findings of these anomalies to avoid misinterpretation and to establish accurate diagnosis. In this article, we review the imaging characteristics of congenital aortic, pulmonary, and aortopulmonary anomalies with an emphasis on multidetector computed tomography findings. We illustrate the CT findings of congenital arterial anomalies such as double aortic arch, right aortic arch, aortic coarctation, pseudocoarctation, interrupted aortic arch, interruption (absence) of the pulmonary artery, pulmonary artery sling, pulmonary artery stenosis, transposition of great vessels, truncus arteriosus, aortopulmonary window, and patent ductus arteriosus.

Preferences of referring physicians regarding the role of radiologists as direct communicators of test results.

PURPOSE Currently, there is a growing need for patient-centered radiology in which radiologists communicate with patients directly. The aim of this study is to investigate the preferences of referring physicians (RPs) regarding direct communication between radiologists and patients. METHODS This study was conducted in a single academic hospital using a survey form. The survey items investigated the preferences of RPs regarding: 1. who should be the communicator of test results when a patient with abnormal findings requests information (the options were the radiologist; another health professional with communication skills training (CST); and the RP with CST); and 2. how the communication activity should be conducted if the radiologist is obliged (or chooses) to communicate with the patient directly (the options were that the disclosure should be limited to the findings in the radiology report; the radiologist should emphasize that the RP is the primary physician; and the communication activity should be conducted in accordance with guidelines established by consensus). The respondents were 101 RPs from various fields of specialty; they were asked to rate the items using a 5-point Likert scale. The effects of age, sex, field of specialty (surgical vs. nonsurgical), and total years of experience as a medical specialist on the ratings were statistically compared. RESULTS Most RPs preferred that the radiologist transmit the information to the RP without communicating directly with the patient (89.1%). Although 69.3% of the RPs declared that health professionals with CST have priority in communication, 86.1% declared that the RP should be the person who received CST. If the radiologist communicates with patients directly, the RPs favored that 1. the disclosure should be limited to the findings in the radiology report (95%); 2. the communication activity should include an emphasis on the RP as the patients primary agent (84.1%); and 3. communication should be conducted in accordance with guidelines established by consensus (73.2%). The percentage of strong opinions did not change significantly with regard to age, sex, field of specialty, or total years of experience, except that surgeons expressed strong disagreement with delegating the communication activity to another health professional who received CST (χ² = 9.9; P = 0.042). CONCLUSION These findings may serve as a basis to implement institutional and national policies for patient-centered radiology.

Percutaneous ultrasound-guided core needle biopsy of solid pancreatic masses: Results in 250 patients

To determine the diagnostic accuracy and complications of percutaneous sonographic (US)‐guided core needle‐needle biopsy in the diagnosis of solid pancreatic masses.

Percutaneous treatment of liver hydatid cysts in 190 patients: a retrospective study:

Background Hydatid liver disease (HLD) is a significant health problem, especially in endemic areas worldwide. Percutaneous treatment is an effective alternative therapeutic option. Purpose To present the clinical and radiological results of percutaneous treatment of HLD in 190 patients. Material and Methods Percutaneous treatment of HLD between April 2005 and March 2015 was analyzed retrospectively. The demographic data, numbers and types of cysts, initial and final volumes of the cysts, types of percutaneous treatment, and procedure-related complications were determined. Results A total of 190 patients (95 male patients and 95 female patients; age range, 5–82 years) with 283 liver hydatid cysts who underwent percutaneous treatment were included in the study. Of the 283 cysts, 234 (83%) were cystic echinococcosis CE1, 31 (11%) were CE3a, and 18 (6%) were CE2 cysts, according to the World Health Organization (WHO) classification. The percutaneous procedure was successful in all patients. A total of 12 (6.3%) major complications, including anaphylaxis, allergic skin reaction, perihepatic hemorrhage, and cavity infection, were seen. No mortality was noted. Recurrence in one patient and an additional cyst in one patient were seen. All patients were asymptomatic during the follow-up period. Mean volume reduction was 77.5%, with a mean follow-up period of 18 months. Conclusion Percutaneous treatment is an effective and safe method for the treatment of HLD. It should be regarded as a first-line treatment method for uncomplicated hydatid cysts.

Acute myocardial infarction due to a large coronary aneurysm in Behçet's disease.

A 32-year-old man with Behcet’s disease presented with typical chest pain of 36-hour onset. His physical examination was normal. Levels of cardiac enzymes and troponin I were increased. Electrocardiography showed ST-segment depression in precordial leads. An emergency invasive intervention was initiated with the diagnosis of subacute anterior myocardial infarction. Coronary angiography showed a large aneurysm in the proximal segment of the left anterior descending artery with TIMI 0 flow (Fig. A). The large aneurysm was also demonstrated by multislice computed tomography (Fig. B, C). The patient underwent an emergency surgical intervention for repair of the coronary aneurysm. Behcet syndrome is a vasculitis that can affect all the arteries and veins. Coronary artery aneurysms are uncommon in Behcet’s disease. Ali Dogan Ahmet Celik† Serap Dogan# Ibrahim Ozdogru

MRI of pneumonia in immunocompromised patients: comparison with CT

PURPOSE Pneumonia is an important cause of mortality and morbidity in immunocompromised patients. Computed tomography (CT) is the most sensitive imaging modality for the diagnosis and surveillance of these patients. Since CT exposes the patient to ionizing radiation, we investigated the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia. METHODS The study included 40 immunocompromised patients with pneumonia documented on CT. The patients were examined by MRI within 48 hours of CT examination. All images were obtained with three different sequences: balanced fast field echo, T1-weighted turbo spin-echo (TSE), and T2-weighted TSE. Lung abnormalities were evaluated using CT and MRI. RESULTS Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P < 0.001, for all). A significant difference was observed between the MRI sequences and CT in terms of the number of detected nodules (P < 0.001). The nodule detection rate of MRI significantly increased in proportion to the size of the nodule (P < 0.001). All MRI sequences had almost perfect agreement with CT for the detection of consolidation (к=0.950, P < 0.001), patchy increased density (к=1, P < 0.001), pleural effusion (к=0.870, P < 0.001), pericardial effusion (к=1, P < 0.001), reverse halo sign, (к=1 P < 0.001), 10-20 mm, nodules (к=0.896, P < 0.001 for CT and B-FFE; к=0.948, P < 0.001 for CT and T1- or T2-weighted imaging) 10-20 mm, >20 mm nodules (к=0.844, P < 0.001). CONCLUSION Although CT is superior to MRI in the diagnosis of pneumonia in immunocompromised patients, MRI is an important imaging modality that can be used, particularly in the follow-up of these patients, thus decreasing to avoid ionizing radiation exposure.

Gossypiboma as a rare cause of abdominal mass

Gossypiboma is a reaction to a foreign body/object left accidentally inside a patient as a consequence of surgery. This phenomenon may be overlooked due to its rarity or under-reported due to possible repercussions. We report an intra-abdominal gossypiboma that was misdiagnosed on ultrasound, and discuss its radiological findings.

Usefulness of Apparent Diffusion Coefficient of Diffusion-Weighted Imaging for Differential Diagnosis of Primary Solid and Cystic Renal Masses

Summary Background To evaluate the value of diffusion-weighted imaging (DWI) for distinguishing between benign and malignant renal masses. Material/Methods Seventy-five patients with 75 unilateral renal lesions were included, and 75 normal contralateral kidneys served as controls. The lesions were categorized into four groups as malignant cystic, malignant solid, benign cystic and benign solid. The apparent diffusion coefficients (ADCs) were evaluated for two different b values (b=600 s/mm2 and b=1000 s/mm2). Receiving operating characteristic analysis was performed to identify threshold ADCs. Results Sensitivity and specificity were 67% and 77% (p=0.003) at the cutoff value of 1.5 for b=600 s/mm2, and 79% and 62% (p=0.004) at the cutoff value of 1.99 for b=1000 s/mm2 as regards the differentiation between solid benign and malignant renal lesions. Sensitivity and specificity were 78% and 79% (p=0.001) at the cutoff value of 3.1 for b=600 s/mm2, and 86% and 61% (p=0.003) at the cutoff value of 2.9 for b=1000 s/mm2 as regrads the differentiation between benign and malignant cystic renal lesions. Conclusions DWI can be an effective diagnostic method for distinguishing between benign and malignant renal masses.

Unusual Reason of Groin Pain: Pelvic Polycystic Kidney Disease

To the Editor: A 42-year-old woman was admitted to our hospital with the complaints of intermittent groin and low back pain for 6 months. The patient had been under losartan treatment due to hypertension for 2 years. On admission, she was fully oriented and hemodynamically stable. Physical examination revealed a heterogenous mass that was palpable over the left lower abdomen and suprapubic region. The left groin was painful with palpation as well. Laboratory test results showed that the hemoglobin level was 12.5 g/dL, blood urea nitrogen was 24 mg/dL, and creatinine level was 0.9 mg/dL; urine analysis revealed 2 positive red blood cells, negative white blood cells, and no casts. Urine culture test results were negative. Clotting tests were all within the normal range. Abdominal ultrasound showed that the patient had polycystic kidneys without kidney stones and ectasia; however, the left kidney was located in the pelvis. Magnetic resonance imaging revealed multiple renal cysts in the right kidney, absence of the left kidney, and an ectopic kidney with multiple cysts in the true pelvis (Figure 1). Autosomal-dominant polycystic kidney disease (ADPKD) may present with acute or chronic pain. Chronic pain is generally due to enlarged cystic kidneys causing stretching of the capsule or traction of the renal pedicle. Mechanical pain also occurs due to enlarged cysts that resulted in lumbar lordosis and back pain. Paraspinal muscle group hypertrophy has been observed in ADPKD patients with back pain. In fact, groin pain is not a usual complaint in patients with ADPKD in the absence of kidney stones or urinary tract infection. In this case, we presented a patient with groin pain with ADPKD and pelvic left kidney localization to diagnose the disease. There were only 2 cases in the literature with pelvic polycystic kidney disease. In conclusion, we suggest that groin pain—with or without urinary tract infection or kidney stones—should alert the clinician to the possible presence of an ectopic organ in the pelvic area.