Ümit Belet

Dyke–Davidoff–Masson syndrome

We reported five cases of Dyke-Davidoff-Masson syndrome (DDMS) with different clinical and radiological findings. The evaluated parameters were the location of the lesions, midline structural shift effect, pathological and morphological changes on the ipsilateral calvarium, paranasal sinuses and mesencephalon, presence of compensatory contralateral hypertrophy. With the help of both magnetic resonance (MR) and computerized tomography (CT) images, changing degrees of all the evaluated parameters were observed in all five of our patients. In conclusion, no relationship was found between parenchymal and calvarial changes and between the time after onset of the disease and amount of the morphologic and pathological changes.

Prevalence of epididymal, seminal vesicle, prostate, and testicular cysts in autosomal dominant polycystic kidney disease

OBJECTIVES To assess the prevalence of cysts in the epididymis, seminal vesicles, prostate, and testes of patients with autosomal dominant polycystic kidney disease (ADPKD) and determine their clinical significance. Extrarenal cystic involvement is a well-known manifestation of ADPKD. Although a few reports exist about cysts in the epididymis, seminal vesicles, prostate, and testes, the true prevalence of cysts in these organs is not well known. METHODS A prospective study, consisting of 104 male patients and 62 male controls, was designed at three medical centers to evaluate the prevalence of epididymal, seminal vesicle, prostatic, and testicular cysts in patients with ADPKD by abdominal, transrectal, and scrotal ultrasound examinations. RESULTS Among the 104 patients, epididymal cysts were present in 19 (18%), seminal vesicle cysts were present in 41 (39%), and prostatic cysts were present in 7 patients (7%); the proportion in the control group was 24% (P >0.05), 2% (P <0.01), and 5% (P >0.05), respectively. Testicular cysts were detected in only 3 control patients. Of the 104 patients, 96 were married, and primary infertility was present in 5 patients (5%). CONCLUSIONS We suggest that seminal vesicle cysts are frequent in ADPKD; epididymal cysts are not uncommon in ADPKD, but the frequency is not higher than in the control group; ADPKD should be looked for in patients with seminal vesicle cysts; and additional studies are necessary to evaluate the association between epididymal and seminal vesicle cysts and infertility in patients with ADPKD.

Results of alcohol and albendazole injections in hepatic hydatidosis: Experimental study

Background:  Percutaneous drainage with alcohol injection for hydatid cysts has been commonly used in the last two decades. Albendazole is the drug of choice in the medical treatment of hydatidosis, and has also been used as an intraoperative scolicidal solution. The side‐effects of its local application are not well known and have not been investigated. The purpose of the present study was to investigate the effects of the intracystic injections of alcohol and albendazole solutions on the hydatid cysts and hepatobiliary system of rabbits.

MR imaging and MR angiography in vascular Behçet’s disease

The aims of this study are to demonstrate the ability of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in the diagnosis and evaluation of vascular involvement in Behçets disease. Twelve patients with vascular involvement due to Behçets disease were included in this study. We believe that MRI and MRA are safe and noninvasive methods that can be used to confirm and monitor vascular Behçets disease.

Huge osteoma of the frontoethmoidal sinus with secondary brain abscess

Osteomas of paranasal sinuses are usually asymptomatic. When enlarged, they may cause serious complications. We report a case of huge frontoethmoidal osteoma associated with brain abscess. If an osteoma associated with an intracerebral pathology is detected, it should be remembered that this could have been a complication of the osteoma and a detailed radiological examination should be performed to show the extent of the osteoma and to confirm any defect at the posterior wall of the sinus which may lead intracerebral complications. Such an osteoma should be operated after the abscess was resolved and patient became stable neurologically.

Gallbladder motility in children with Down syndrome.

Objective: The aim of this study was to investigate gallbladder motility in children with Down syndrome by measuring gall-bladder volume and contraction index. Methods: This study, performed between January 2001 and December 2002 at the Ondokuz Mayis University, School of Medicine, Department of Paediatric Neurology, Samsun, Turkey, included 21 patients with Down syndrome (study group) and 22 healthy children (control group). After an 8-hour fast, gallbladder diameters in both groups were measured in length, width, and height by ultrasonography before and 30 minutes after a test meal. The volume of gallbladder before and after a test meal was determined, and the contraction index was calculated. Blood triglyceride and cholesterol levels were measured, and 5-hydroxyindoleacetic acid (5-HIAA) levels in urine were determined. Results: Mean gallbladder volume before test meal in the study group and controls was 8,412.4 ± 5,174 mm3 and 16,516.8 ± 6,796.1 mm3 (P < 0.001), respectively. The mean contraction index of the study group was 41.2% ± 19.4% and of controls, 75.0% ± 12.3% (P < 0.001). The mean triglyceride level of the study group was significantly higher than controls (P < 0.05). The mean urine 5-HIAA level of the study group was lower than controls (P < 0.05). Conclusion: CI was lower in patients with Down syndrome, suggesting gallbladder hypomotility. Hypomotility may be a feature associated with the high prevalence of gallstones in Down syndrome.

Proboscis lateralis: radiological evaluation.

Abstract. Proboscis lateralis is a rare craniofacial anomaly. It consists of a soft, trunk-like process that originates from the medial portion of the orbital roof and it may be accompanied by a number of facial and cerebral anomalies. The characteristics and relationship of the lesion to adjacent structures should be known, and associated anomalies should be detected before surgical correction. The patient should undergo neuroimaging studies besides clinical evaluation to obtain this information in detail. The neuroimaging findings of only one previous case are available in the literature. We report two cases of proboscis lateralis evaluated by CT and MRI before corrective surgery.

Coumadin-Induced Renal and Retroperitoneal Hemorrhage

Principles. Coumadin-induced renal and retroperitoneal hemorrhages are rare. Clinical and laboratory findings are not specific for the diagnosis. Computed tomography (CT) has some advantages in the evaluation of these patients. The aim of this study is to report our experience regarding renal and retroperitoneal hemorrhage due to Coumadin, and describe clinical and CT findings, treatment, and prognosis of the patients. Methods. We reviewed our CT archive to search patients with renal and retroperitoneal hemorrhage caused by Coumadin treatment retrospectively. A total of seven patients with Coumadin-induced renal and retroperitoneal hemorrhages were included in this study. Results. Four patients had abdominal pain, two patients had hematuria, and one patient had abdominal pain and hematuria. There was retroperitoneal hemorrhage in three patients on abdominal CT. One patient had hemorrhage in the renal pelvis and the jejunum, another had hemorrhage in the renal pelvis and the perirenal area, and another had hemorrhage in the perirenal area and the retroperitoneal region. In the last patient with hematuria, there was no hemorrhage. None of the patients had a lesion-causing hemorrhage. Coumadin was stopped, and vitamin K and fresh-frozen plasma were given to patient. One patient with massive retroperitoneal hemorrhage died, whereas other patients were successfully treated using conservative approaches. Conclusions. Hematuria and abdominal pain are the most common complaints in Coumadin-induced renal and retroperitoneal hemorrhage. CT can be the first imaging modality in these patients due to its ability to directly evaluate all peritoneal and retroperitoneal structures. It also allows evaluation of any underlying lesion that can cause hemorrhage from the renal area and the urinary tract. Conservative treatment is the first choice, and prognosis is good when diagnosed early.

The advantages of MRI and MRA for diagnosing Behçet's disease and internal jugular vein thrombosis

Behçets disease is a multisystem disorder characterized by recurrent aphtous ulcers of mucosal membranes, skin lesions, and vasculitis. The prevalence of vascular involvement is about 25% and this is the leading cause of death in Behçets disease. Jugular vein involvement is an unusual manifestation of Behçets disease. Medical insertion of needles into veins or arteries can induce thrombosis or aneurysms. Thus, diagnostic studies or therapy can aggravate the disease and even be fatal. We report a patient with Behçets disease and rare internal jugular vein thrombosis. We also demonstrate the ability of noninvasive magnetic resonance imaging and magnetic resonance angiography to aid in the diagnosis and evaluation of vascular involvement in Behçets disease, without risking iatrogenic complications.

Ascariasis of the gallbladder: radiological evaluation and follow-up

A 10-year-old boy presented with fever, jaundice, abdominal pain and vomiting. There was hepatomegaly and right upper quadrant tenderness. US identified a dilated gallbladder containing a moving, linear echogenic structure with a central anechoic lumen (Fig.1). Cholangitis secondary to ascariasis was diagnosed. US also showed multiple adult roundworms in the smallbowel lumen. Gallbladder ascariasis was also confirmed by CT and MRI. Ascaris eggs were detected in the faeces. Antibiotic treatment was given, but antiparasitic drugs were not prescribed. Three days later, US showed the Ascaris in the main hepatic duct; after another 4 days, the worm had disappeared from the biliary tree. After antiparasitic treatment had been given, the patient was discharged with no clinical or US abnormality. Adult roundworm invasion into the gallbladder is very rare and accounts for 2.1% of hepatobiliary ascariasis [1]. Worm migration can also result in biliary obstruction [2]. Biliary ascariasis is best shown by US identification of worms inside the biliary tree or gallbladder [3]. US findings include a nonshadowing, long, mobile echogenic strip with central anechoic tube [1]. Cholecystectomy, choledochotomy and other interventions have been used in the treatment of hepatobiliary ascariasis [4]. The motion of the Ascaris can be observed by US and this will indicate whether it is alive or not, an advantage of US over CT and MRI. US is also useful to monitor the progress of the worm in the hepatobiliary system. After the worm returns to the small bowel, it can be effectively treated with antiparasitic drugs. Thus, surgery, other interventions and their complications can be prevented by timing antiparasitic treatment in accordance with the findings of US monitoring.