Yuksel Pabuscu

Prevalence of testicular microlithiasis in an asymptomatic population

Testicular microlithiasis is a rare, usually asymptomatic, finding of the testes associated with various genetic anomalies and infertility. It is also widely believed that testicular microlithiasis is strongly associated with testicular tumor. The aim of this prospective study was to determine the true prevalence of testicular microlithiasis in an asymptomatic population by means of ultrasound screening. Healthy male volunteers (17–42 years old) were recruited from the annual Army Reserve Officer Training Corps training camp at Manisa, Turkey. A screening genitourinary history was obtained and a physical examination and screening scrotal ultrasound scan were performed. All men diagnosed with testicular microlithiasis underwent complete clinical evaluations, physical examinations and determination of tumor markers. Fifty-three men with testicular microlithiasis were identified from the 2179 ultrasound scans, giving a prevalence of testicular microlithiasis of 2.4% in this asymptomatic population. The age (mean±SD) of subjects with testicular microlithiasis was 23.9±4.2 years (range 20–31 years). Our results suggest that there is no significant association between TM and testicular cancer, although it is difficult to rule out such an association without further studies with a longer follow-up period.

Comparison of 3 Physical Therapy Modalities For Acute Pain in Lumbar Disc Herniation Measured by Clinical Evaluation and Magnetic Resonance Imaging

OBJECTIVE This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH). METHODS A total of 60 patients were enrolled in this study and randomly assigned into 1 of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at 1 and 3 months after treatment. RESULTS There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups. CONCLUSIONS This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.

Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy

This study was designed to evaluate the swallowing function in patients with supracricoid laryngectomy (SCL) compared to normal subjects and to search for the factors affecting postoperative aspiration. Ten patients who underwent SCL with cricohyoidopexy (CHP) for primary laryngeal squamous cell carcinoma were included in the study. The control group consisted of 13 normal adult volunteer men with similar ages. The swallowing act of the subjects was evaluated by using videofluoroscopy (VFS) and videolaryngostroboscopy (VLS). The movements of the larynx were measured with regard to the hyoid bone, mandible and vertebral spine. The patients with SCL-CHP, except for two who had slight aspiration, had effective and near normal swallowing regarding the measurements of the movements of the hyoid bone. They could tolerate a near-normal oral diet. We have observed that the preventive precautions for aspiration are preserving the superior laryngeal nerves, suturing and positioning the cricoarytenoid unit as anterosuperiorly as possible, early decannulation and early onset of swallowing rehabilitation; the risk factors for aspiration are advanced stage of cancer, postoperative radiation and shortening of bolus transit time. VFS is useful for the patients with postoperative aspiration, because it is the definitive technique for anatomical and physiological evaluation of swallowing. We consider that the parameters of VLS and VFS, such as tongue base-arytenoid contact, presence of bolus splitting, pseudoepiglottis function, maximal opening of the pharyngoeosophageal sphincter and total movement of hyoid bone are important criteria to evaluate swallowing.

Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome

Objective. To investigate the anatomic and hemodynamic properties of testicular venous drainage and its effects on varicocele formation and reflux using color Doppler ultrasound (US) with emphasis on renal vein entrapment syndrome. Material and methods. Upper abdominal and scrotal US examinations of 35 varicocele patients and 35 healthy male subjects were performed in the supine position during rest, during a Valsalva maneuver and in the erect position. The aortomesenteric angle and distance (AMA and AMD, respectively), peak mean velocities (PVs) and diameters of different segments of renal veins, testicular vein diameters and duration of flow inversion were measured. Results. In the varicocele group, the lateral segment of the left renal vein (LRV) had a larger diameter and slower PV, and the medial segment of the LRV had a smaller diameter and faster PV. The diameter of the dominant draining vein correlated with the PV of the medial and lateral segments of the LRV, whereas there was no correlation between the diameter of the dominant draining vein and the diameters of the right renal vein (RRV) and the lateral segment of the LRV or the PV of the RRV. The duration of flow inversion correlated with the diameter and PV of the medial segment of the LRV. No correlation between the diameters and PVs of the RRV and the lateral segment of the LRV was detected. Conclusions. The decreases in the AMA, AMD, diameter of the medial segment of the LRV and PV of the lateral segment of the LRV, and the increases in the PV of the medial segment of the LRV and the diameter of the lateral segment of the LRV in varicocele patients in all positions suggest the entrapment or impingement of the left renal vein between the aorta and the superior mesenteric artery. This has been defined as the “nutcracker phenomenon”, which is known to affect varicocele formation.

A mass screening survey of cystic echinococcosis by ultrasonography, Western blotting, and ELISA among university students in Manisa, Turkey.

Cystic echinococcosis (CE) is one of the most important zoonotic diseases in a wide geographic area, including Turkey. In the present project, a total of 4275 students from Celal Bayar University, Manisa, Turkey, were screened by ultrasonography (US) and specific antibodies for CE were examined by Western blotting (WB) and ELISA in finger prick blood samples of 2034 of 4275 volunteered students. We aimed to report the apparent prevalence of CE based on different diagnostic procedures and to compare WB and ELISA with US in diagnosis of CE in a mass screening setting. Six new cases were diagnosed as CE by US during the survey. In addition to these cases, three students were also detected to have been previously operated and pathologically confirmed for hepatic CE. US revealed parenchymal changes in these cases in concordance with their operation history; so, the prevalence of CE by US was calculated as 0.21% (9/4275) (95%CI, 0.11-0.39%) among university students in Manisa. Bands were detected at 8, 28, 32, 38, 42, 47, 70 and 90kDa by WB and the cases were considered to be positive for CE when at least three of the bands were seen together. Apparent prevalence of CE by ELISA and WB were found to be 2.11% (43/2034) (95%CI, 1.57-2.83%) and 0.25% (5/2034) (95%CI, 0.10-0.57%), respectively. Of the six US positive cases, WB was positive in only one case with two cysts in the liver. All of four cases with liver involvement were positive by ELISA. The high prevalence of CE among university students in Manisa indicated that CE is a major health problem in this area of Turkey. Our results supported that WB is rather difficult and not feasible as a mass screening test and may not be effective for confirmation especially in asymptomatic cases. As a result, we recommend US to be used initially in mass screening surveys for CE followed by confirmation by ELISA for suspected cases. Further examination primarily by chest X-ray followed by computed tomography and/or magnetic resonance imaging, if needed, should be recommended for US negative, ELISA and WB positive individuals who may have non-abdominal cysts.

Radiologic features of lumbar spine in ochronosis in late stages

Ochronosis is a rare hereditary disorder of tyrosine metabolism. Severe degenerative arthritis and spondylosis occur in the later stages of this disease. Radiologic examinations may reveal changes considered almost pathognomonic for ochronosis. We present the radiologic features of the lumbar spine in two ochronotic patients who were diagnosed after radiologic examinations in the late stages of the disease.

Transformation of the maxillary bone in adults with nasal polyposis: a CT morphometric study.

PURPOSE Nasal polyposis (NP) in adult population is a common problem in otorhinolaryngology outpatient practice. Computed tomography (CT) is the ideal imaging method to investigate paranasal sinus diseases. There is yet no study in the literature measuring the morphometry of maxillary bone in NP. The objectives of this study are to correlate the airway variables obtained by CT findings of both chronic nasal airway obstruction and control group in an adult population, and to investigate whether the bony structure of the airway is affected or not. MATERIALS AND METHODS Forty NP cases that were followed up for 1-5 years by an otorhinolaryngologist were included in this retrospective study. Forty subjects who had normal findings reported on paranasal CT scans were randomly selected from our CT database as the control group. Maxillary and palatine bones (PB) were evaluated: the plane angle between the maxillary alveolar processes (MAP) and PB, and depth of the maxillary arch of both groups were compared. RESULTS The mean angle between MAP and PB plane was wider in the NP group (right 128.1 +/- 8.5 degrees and left 126.2 +/- 8.5 degrees ) than control group (right 106.6 +/- 8.1 degrees and left 105.5 +/- 7.3 degrees). The mean depth of maxillary arch was significantly smaller in the NP group (1.2 +/- 0.2 cm) than in the control group (1.4 +/- 0.2 cm). CONCLUSION There could be a relationship between nasal polyposis in adults and maxillary shape. The flattening and shallowing of the maxillary arch detected in patients with NP may indicate that the bony structural changes continue in adulthood.

Doppler sonographic findings in testicular microlithiasis

OBJECTIVE The aim of this prospective study was to compare the resistive index (RI) values, which is a parameter of testicular parenchymal perfusion, in testicular microlithiasis (TM) cases and normal cases. MATERIALS AND METHODS 2179 volunteers, all healthy men (17-42 years of age) from the Annual Army Reserve Officer Training Corps training camp were included in the study. A screening scrotal ultrasound was performed and all men diagnosed with TM underwent a scrotal Doppler ultrasonography scan (US). US examinations were performed for subjects with TM and without TM as a control group and RI was determined. RESULTS 53 men with TM were identified in the 2179 US. Spectral Doppler examination was applied to 50 randomly selected cases (100 testicles) without TM and 92 testicles with TM, 39 cases (78 testicles) with bilateral and 14 cases with unilateral involvement. However, 48 normal testicles (17 bilateral and 14 unilateral) and 47 testicles with TM (15 bilateral and 17 unilateral, 10 of which were cases with bilateral TM) where flow from the centripetal artery could be obtained and analyzed were included in the statistical analysis for resistive indices. There was no significant difference regarding the RI and spectral examinations between subjects with and without TM. An interesting finding was the twinkling artifact observed in three cases. CONCLUSION Microliths did not alter the RI values and thus had no influence on testicular perfusion on Doppler US examination.

Sonographic-Guided Injection of Corticosteroid in the Treatment of Lateral Epicondylitis

Objective: In this study the advantage of ultrasonography [US] in diagnosis and therapy of lateral epicondylitis [LE] was investigated in patients with lateral elbow pain and clinically diagnosed as LE. Methods: Fifty-two patients with LE were examined using sonography. For the patients in whom normal US examination was found, a blind injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine was performed [Group 1]. The patients whose clinical diagnosis was confirmed with US received a sonographic-guided injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine [Group 2]. Outcome measurements were performed at baseline, two weeks, one month, and three months. Pain and functional status were assessed using a visual analog scale, physical functioning and bodily pain scales of the Medical Outcomes Study 36 Item Short-Form Health Survey, a patient-rated forearm evaluation questionnaire, and a patient-specific functional scale. Painless grip strength bilaterally was also measured. Results: Twenty-four [46.2 percent] patients had a normal-appearing common extensor origin on US. The group in which diagnosis of LE was confirmed on US and sonographic-guided corticosteroid injections improved significantly from the baseline to the third month follow up [P < 0.000] in both clinical assessment and physical examination findings. Conclusions: Our case series suggested that sonography of the common extensor origin can be used to confirm LE in patients with lateral elbow pain. Although sonographic-guided injections produced more clinical improvement, further studies are needed to determine effectiveness of sonographic-guided injections.

The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography

INTRODUCTION The exact etiology of Bells palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. OBJECTIVE To identify if there is any relationship between the grade of Bells palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bells palsy including parts which have not been studied before. METHODS Medical records and temporal computed tomography scans of 34 patients with Bells palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bells palsy. Significant differences were established at a level of p=0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). RESULTS Thirty-four patients - 16 females, 18 males; mean age±Standard Deviation, 40.3±21.3 - with Bells palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p=0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p=0.87), tympanic segment (p=0.66), second genu (p=0.62), mastoid segment (p=0.67) and stylomastoid foramen (p=0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p=0.41), tympanic segment (p=0.12), mastoid segment (p=0.14), geniculate ganglion (p=0.13) and stylomastoid foramen (p=0.44), while we found significant relationship at the level of second genu (p=0.02). CONCLUSION We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bells palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.