Tamer Baysal

Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus

The metabolite changes in the brains of children with poorly controlled typexa01 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9±3.4 (8.2–19.4). The average number of keto-acidosis episodes was 1.9±2.2 (0–9) and the average number of daily insulin injections was 2.8±0.97 (2–4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled typexa01 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.

The crowned dens syndrome : a rare form of calcium pyrophosphate deposition disease

The crowned dens Syndrome has been termed as acute neck pain ascribed to CPPD deposits associated with a tomographic appearance of calcification surrounding the odontoid process. This rare entity resulting in cervical cord compression is generally seen in older female patients. We present a 26-year-old woman with cervical cord compression due to massive calcification in the periodontoid area and discuss the X-ray and CT findings of the disease.

Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis

The purpose of this study was to evaluate the Doppler sonographic blood‐flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission‐phase) ulcerative colitis (UC).

Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions

The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000xa0s/mm2) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42±0.76×10–3xa0mm2/s. Exudates had a mean ADC value of 3.18±1.82×10–3xa0mm2/s. The optimum cutoff point for ADC values was 3.38×10–3xa0mm2/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements (r=–0.69, –0.66, and –0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.

Diffusion-weighted magnetic resonance imaging in differentiation of postobstructive consolidation from central lung carcinoma

PURPOSEnTo prospectively evaluate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiation of postobstructive consolidation from centrally located lung carcinomas by using apparent diffusion coefficients (ADCs).nnnMATERIALS AND METHODSnAn institutional review board approved this study; informed consent was obtained from patients. Forty-nine consecutive patients (3 women, 46 men; mean age, 63.6 years; age range, 42-85 years) with lung carcinoma underwent DW MR imaging. Forty patients had central and nine patients had peripheral lung carcinomas. ADC of each lung carcinoma was calculated from DW MR images obtained with two different b values (0, 1000 s/mm(2)). In the final study group including 27 patients with central lung carcinoma accompanying distal lung consolidation (mean age, 67.2 years; 3 women, 24 men), ADCs of lung carcinomas were statistically compared among cytologic/histologic types and accompanying postobstructive consolidations. Unpaired t test was used for measurable variables with normal distribution, and Kruskal-Wallis variance analysis and Mann-Whitney U tests were used for the measurable variables without normal distribution.nnnRESULTSnThere was no significant difference between mean ADC values of all types of carcinomas (P=.302) and also between mean ADC values of central (1.91 +/- 0.7x10(-3) mm(2)/s) and peripheral carcinomas (1.58 +/- 0. 6x10(-3) mm(2)/s) (P=.224). The mean ADC value for the masses of central lung carcinoma with postobstructive consolidations was 1.83 +/- 0.75x10(-3) mm(2)/s, and for consolidation was 2.50 +/- 0.76x10(-3) mm(2)/s. ADC of central carcinoma masses was significantly lower than that of postobstructive consolidations (P=.003).nnnCONCLUSIONSnADC values of central lung carcinoma masses appear to be lower than accompanying postobstructive consolidations. ADC values could be considered useful as a differentiating parameter among central lung carcinomas and accompanying postobstructive consolidations.

Cervical myositis ossificans traumatica: a rare location

Abstract. An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.

Allergic granulomatosis and angiitis in the absence of asthma and blood eosinophilia: a rare presentation of limited Churg-Strauss syndrome.

Allergic granulomatosis and angiitis, also known as Churg-Strauss syndrome (CSS), is an uncommon vasculitis of unknown etiology. We report a 21-year-old male patient with fatigue, dry cough, and progressive dyspnea. He had no history of asthma or eosinophilia. Thorax computed tomography showed bullous/cystic areas with thin walls in varying sizes (5–15xa0mm). Histopathological examination of the open lung biopsy revealed granulomatous infiltration with histiocytes and eosinophilic leukocytes. This extremely rare variant of CSS is discussed.

Early MRI findings in stab wound of the cervical spine: two case reports

Abstract. MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings.

Diffusion-weighted imaging in chronic Behçet patients with and without neurological findings

Our aim was to investigate whether neurological impairment in chronic Behçet’s disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p<0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behçet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent.

Primary intestinal lymphangiectasia : A rare disease in the differential diagnosis of acute abdomen

Primary intestinal lymphangiectasia (PIL) is a rare disease of childhood characterized by edema, hypoproteinemia, and diarrhea (1). Waldmann et al., in 1961, were the first to describe this lymphatic disease as a separate clinical entity causing intestinal protein loss (2,3). Primary intestinal lymphangiectasia is thought to be congenital; the abnormal lymph vessels are located primarily at the level of small intestine (3). The wide spectrum of clinical and laboratory manifestations are determined by the anatomic location and extent of the lymphatic anomaly (4). We report a case of PIL presenting with acute abdominal symptoms and managed with resection of the macroscopically involved segment.