Suha Sureyya Ozbek

Associations of Triiodothyronine Levels with Carotid Atherosclerosis and Arterial Stiffness in Hemodialysis Patients

BACKGROUND AND OBJECTIVES End-stage renal disease is linked to alterations in thyroid hormone levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low triiodothyronine (T3) levels. These alterations are involved in endothelial damage, cardiac abnormalities, and inflammation, but the exact mechanisms are unclear. In this study, we investigated the relationship between serum free-T3 (fT3) and carotid artery atherosclerosis, arterial stiffness, and vascular calcification in prevalent patients on conventional hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS 137 patients were included. Thyroid-hormone levels were determined by chemiluminescent immunoassay, carotid artery-intima media thickness (CA-IMT) by Doppler ultrasonography, carotid-femoral pulse wave velocity (c-f PWV), and augmentation index by Sphygmocor device, and coronary artery calcification (CAC) scores by multi-slice computerized tomography. RESULTS Mean fT3 level was 3.70 ± 1.23 pmol/L. Across decreasing fT3 tertiles, c-f PWV and CA-IMT values were incrementally higher, whereas CACs were not different. In adjusted ordinal logistic regression analysis, fT3 level (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97), age, and interdialytic weight gain were significantly associated with CA-IMT. fT3 level was associated with c-f PWV in nondiabetics but not in diabetics. In nondiabetics (n = 113), c-f PWV was positively associated with age and systolic BP but negatively with fT3 levels (odds ratio = 0.57, 95% confidence interval 0.39 to 0.83). CONCLUSIONS fT3 levels are inversely associated with carotid atherosclerosis but not with CAC in hemodialysis patients. Also, fT3 levels are inversely associated with surrogates of arterial stiffness in nondiabetics.

Regression of splenic vein aneurysm following resolution of splenomegaly

Aneurysms of the portal venous structures have rarely been reported. We present a case of a splenic vein aneurysm that appeared and regressed in parallel with splenic size during the course of a systemic infection in a patient with leukemia. The aneurysm was demonstrated with B‐mode and color Doppler sonography and computed tomography. After appropriate therapy, the spleen diminished in size. This decrease was accompanied by regression of the aneurysm. Color Doppler sonography enables the noninvasive detection, diagnosis, and follow‐up of splenic vein aneurysms.

False-positive I-131 accumulation in a hepatic hydatid cyst.

In this report, a case of differentiated thyroid carcinoma having false-positive I-131 accumulation due to a large hydatid cyst in the liver is presented. Abdominal sonographic examination of a 37-year-old patient with differentiated thyroid carcinoma demonstrated an ovoid, complex cystic mass containing cystic parts as well as solid-appearing components in the right lobe of liver, which is concordant with a type CE-3 hydatid cyst. The postablative whole-body scan obtained 10 days after 100 mCi I-131 therapy displayed intense and homogeneous uptake of radioiodine in the liver. Hepatic cystic mass was removed, and postoperative histologic evaluation confirmed hydatid disease. Some cystic lesions of the kidney and liver have been previously reported as causes of false-positive radioiodine accumulation.

Hemodynamic disorders in Internal thoracic artery : How often are they associated with subclavian steal via ipsilateral vertebral artery?

The scores based on Doppler sonographic spectral features in 14 vertebral arteries with flow reversal and 10 vertebral arteries with normal antegrade flow were correlated with those of ipsilateral internal thoracic (or internal mammary) and subclavian arteries. The statistical analysis revealed significant correlation between the scores of all ipsilateral arteries. We concluded that color duplex ultrasonographic examination of internal thoracic arteries should be carried out in all patients with flow reversal in vertebral arteries. It is especially important in those who are potential candidates for coronary revascularization using in situ internal thoracic artery graft.

Unusually large cisterna chyli: US and MRI findings

We report a rare appearance of cisterna chyli appearing as a giant cystic structure on routine abdominal ultrasonography (US). Diagnosis was established with color Doppler US and after magnetic resonance imaging. This report describes an unusual appearance of the cisterna chyli that radiologists should be familiar with, especially on the routine conventional gray-scale US to avoid mistaking it for a pathologic condition.

Prenatal sonographic detection of nasopharyngeal teratoma.

We present the case of a 34‐year‐old pregnant woman who had an elevated maternal serum α‐fetoprotein level and sonographic findings of a semisolid mass protruding from the fetuss oral cavity. The large, heterogeneous mass filled the oropharynx and nasopharynx. Abnormal Doppler waveforms were detected in the umbilical artery of the fetus, who died in utero. Postmortem examination revealed a nasopharyngeal teratoma.

US findings in euthyroid patients with positive antithyroid autoantibody tests compared to normal and hypothyroid cases.

PURPOSE We aimed to compare the ultrasonographic and laboratory parameters of euthyroid patients who have only positive antithyroid autoantibody test results with those of patients with a hypothyroid status of Hashimotos thyroiditis (HT). MATERIALS AND METHODS Thirty-five patients with newly diagnosed HT, 35 euthyroid patients who have autoantibodies against thyroid peroxidase (TPOAb) and/or thyroglobulin (TgAb), and 40 controls were enrolled in the study. Plasma free T3, free T4, thyroid stimulating hormone, TPOAb, and TgAb levels were obtained retrospectively. For gray-scale ultrasonography, each thyroid gland of all individuals graded with gray-scale grading (GSG), which was determined according to the gland size, parenchymal structure, echogenicity, micronodulation, contour irregularity, and existence of hyperechoic septa. For Doppler analysis, the peak systolic velocity (S), resistive index (RI), and pulsatility index (PI) values were obtained from the superior thyroid artery (STA) and intrathyroidal artery (ITA). The color pixel ratio (CPR), which was computationally evaluated from a power Doppler image of all individuals, was used for quantification of the intrathyroidal vascularity. RESULTS Although the mean GSG values were higher in the HT and antibody-positive groups than they were in the control group, there was no significant difference between the HT and antibody-positive groups. The three study groups demonstrated no statistically significant difference with regard to the S, RI, or PI variables obtained from the STAs and ITAs. Although the CPR values were highest in the HT group, the difference between the HT and antibody-positive group did not reach statistical significance. CONCLUSION The euthyroid antibody-positive group revealed gray-scale and Doppler ultrasonographic findings that were similar to those of the HT group.

Color-Doppler Imaging in Acute Scrotal Disorders

Eighteen patients who referred to our hospital with acute scrotal pain and swelling were evaluated with color-Doppler imaging (CDI) after the initial clinical examinations. Five of these subjects were considered to have testicular torsion as diagnosed with CDI. These diagnoses were surgically confirmed, and appropriate treatments were performed. CDI findings of 13 patients were in accordance with inflammatory pathologies (epididymitis and/or orchitis). These patients received medical treatment. The CDI diagnoses of all patients were in agreement with the final clinical diagnoses. We conclude that CDI, which is a practical, rapid and high-resolution technique, promises to be the leading and decisive scanning method in acute scrotal disorders.

Computed tomography findings in lipoid proteinosis: report of two cases

Lipoid proteinosis (Urbach-Wiethe disease (Urbach, E and Wiethe, C, Lipoidosis cutis mucosae, Virchows Arch. Patholog. Anat., 273, 285-319 (1929)) is a rare generalized disease with autosomal recessive inheritance. It most often involves the skin and mucosal membranes of the aerodigestive tract; but also involves the central nervous system, lung, lymph nodes and striated muscles. We present the computed tomography findings in the cranium and larynx of two siblings with lipoid proteinosis.

Evaluation of Renal Transplant Scintigraphy and Resistance Index Performed Within 2 Days After Transplantation in Predicting Long-Term Graft Function.

Purpose Value of renal transplant scintigraphy and resistance index (RI) in the assessment of renal graft function is well known. The aim of this study was to evaluate the predictive value of renal transplant scintigraphy and RI for long-term graft function. Materials and Methods A total of 119 patients were analyzed retrospectively. Renal transplant scintigraphy with technetium Tc 99 m DTPA and color Doppler ultrasonography for RI were performed to each patient within 2 days after transplantation. Resistance index and the results of the tests in perfusion/renographic curve analysis of scintigraphy were compared with the serum creatinine (sCr) levels at 3 months, 1 year, and 5 years after transplantation. A sCr level of more than 1.5 mg/dL was considered abnormal. Results Differences of the mean values of T½ of graft washout (GW½), time difference between peak renal perfusion and arterial count ([INCREMENT]P), and accumulation index (R20/3) were significantly high in patients with high follow-up sCr (>1.5 mg/dL) (P < 0.01). The correlation of these tests with the follow-up sCr levels was significant (P < 0.01). The number of recipients with high perfusion curve grade was also significant in the follow-up groups with high sCr levels. However, difference of the mean value of RI was insignificant between the follow-up groups, and there was no correlation between the RI and sCr levels. Conclusion Renal transplant scintigraphy performed within 2 days after transplantation is useful in the prediction of long-term graft function at 3 months, 1 year, and 5 years; and it is superior to resistance index.