Zafer Özmen

Is evaluation of placenta with real-time sonoelastography during the second trimester of pregnancy an effective method for the assessment of spontaneous preterm birth risk? ☆

PURPOSE The aim of this study is to investigate the effectiveness of placental strain ratio (SR) values measured by real-time sonoelastography (SE) in the second trimester in the prediction of spontaneous preterm birth (sPTB). METHODS This study included 70 pregnant women who applied to our clinic for routine second-trimester screening. Placental SR measurements were performed with the SE method. Two different SR measurements were performed by taking two different tissues as references. The SR value measured when taking the rectus abdominis muscle as a reference was termed the muscle-to-placenta strain ratio (MPSR), while the SR value measured when taking subcutaneous tissue as a reference was termed the fat-to-placenta strain ratio (FPSR). Women whose gestational age at birth was less than 37 weeks 0 days were accepted as sPTB. The association between gestational age at birth and MPSR and FPSR was investigated. Receiver operating characteristics analysis was used to calculate the sensitivity and specificity of the elastographic outcomes. RESULTS There was a low-level negative correlation between MPSR and gestational age at birth (r=-0.300, P=.012) and there was a moderate-level negative correlation between FPSR and gestational age at birth (r=-0.513, P<.001). The multivariate linear regression analysis showed that the FPSR (β=0.609, P=.002) was the significant predictor for the sPTB. CONCLUSIONS Our data indicate that the FPSR value measured with real-time SE in the second trimester of pregnancy may be effective in the prediction of sPTB.

Does the Percutaneous Internal Ring Suturing Technique Impair Testicular Vascularization in Children Undergoing Inguinal Hernia Repair

PURPOSE The aim of this study was to evaluate the effect of the percutaneous internal ring suturing (PIRS) technique on testicular vascularization when used for inguinal hernia repair in children. SUBJECTS AND METHODS In this prospective study, 49 boys older than 1 year who had been diagnosed with unilateral inguinal hernia were evaluated. Hernias were repaired using the laparoscopic PIRS technique. The testes of each patient were examined using Doppler ultrasound at the preoperative, early postoperative, and late postoperative periods. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI) of the intratesticular centripetal and testicular capsular arteries were determined. RESULTS PSV, EDV, and RI of the centripetal and capsular arteries were similar between preoperative, early postoperative, and late postoperative periods, with no statistically significant differences detected. CONCLUSIONS Testicular vascularization was not affected by hernia repair using the PIRS technique in our study. We therefore conclude that PIRS is a safe technique for inguinal hernia repair with respect to testicular vascularization.

Ectopic Ureter Accompanied by Duplicated Ureter: Three Cases.

We report cases of ectopic ureter accompanied by three types of ureteral duplication that had been diagnosed previously and treated for enuresis. Data from three female patients ranging in age from 1 to 10 years were evaluated. The ectopic ureter was observed on the left in one case, on the right in another and bilateral in the third case. Complete duplication was found in two cases, while the third had incomplete duplication. Ureteroneocystostomy was performed in one case and subtotal nephrectomy was carried out in the other two cases. Ureteroneocystostomy was performed for the ectopic ureter found in the opposite urinary system in one of the cases. Ectopic duplicated ureter should be considered in treatment-resistant enuresis and urinary tract infections and after a careful physical examination, imaging as well as function tests should be performed.

Percutaneous cavitary lavage in the diagnosis of pulmonary cavities

OBJECTIVE To investigate diagnostic significance of percutaneous cavitary lavage (PCL) in differential diagnosis of benign and malignant pulmonary cavitary lesions. METHODS An alternative diagnostic method called PCL was performed on 16 patients having peripherally located pulmonary cavitary lesions with thin walls which were not suitable for tissue biopsy and whose diagnosis could not be made by sputum examination and bronchoscopic procedures. A 22-gauge needle was inserted into the cavity under computed tomography (CT) guidance. Saline was injected through the needle and then aspirated. The specimen was examined cytologically and microbiologically. RESULTS PCL could make a correct diagnosis in 12 of 16 patients (75%). In three patients (18.7%) appropriate specimen could not be taken. Diagnostic sensitivity and specificity of PCL for malignant-benign differentiation was 80% and 100%, respectively. The accuracy of PCL for this differentiation was 92.3%. There was only one complication, a small pneumothorax resolved without any intervention. CONCLUSIONS PCL is an alternative method in the differential diagnosis of thin walled pulmonary cavitary lesions especially for patients whose diagnosis could not be made by sputum and bronchoscopic procedures and who are not suitable for cutting needle biopsy.

MRI findings of a postpartum patient with reversible splenial lesion syndrome (RESLES)

A 19-year-old female presented at the twentieth day postpartum with severe headache, nausea and vomiting. She had no history of hypertension. Ambulatory blood pressure measurement values were normal. Proteinuria was not detected. In blood analysis, D-dimer level was normal. In addition, MR venography for sinus vein thrombosis was normal. However, MR imaging of the brain showed a lesion measuring approximately 1.5 cm in diameter in the splenium of the corpus callosum (SCC) (Fig. 1a–c). The lesion was hyperintense on the T2A sequences and showed limitation of diffusion on the diffusion-weighted sequences. Although the patient’s complaints regressed within 1 week, there were no changes in the MRI findings at that time. The lesion was found to be completely healed on the control MRI examination 1 month later (Fig. 2a–c). Acquired lesions of the corpus callosum may be secondary to a wide variety of diseases. These include hydrocephalus, ischemia, disorders of the white matter, tumors and trauma. In recent years, the presence of specific reversible lesions involving the SCC has been associated with many different origins, such as infection, high-altitude cerebral edema, seizures, antiepileptic drugs and metabolic disorders [1]. This type of lesion is termed reversible splenial lesion syndrome (RESLES), which is a clinical radiological syndrome (Fig. 2). RESLES is a clinical condition that has recently been diagnosed with increasing frequency. There are currently no specific clinical diagnostic criteria; however, acute neurological disorders, mental-state changes, headache, nausea and radiological evidence of a splenial lesion support the diagnosis. The pathophysiology of splenial lesions is difficult to understand. Most studies on RESLES cases suggest cytotoxic edema in the SCC. This reversible pattern in the diffusion-weighted sequences is different from the subgroup of persistent ischemia that shows ADC reduction. A similar pattern is observed in hemiplegic migraines and venous sinus thrombosis [2]. A splenial lesion on MRI is the key radiological finding in this condition. On diffusion-weighted images, there is a typical limitation to the SCC. MRI findings are expected to regress spontaneously within a few weeks to months. Clinical conditions such as epilepsy, anticonvulsant withdrawal, acute disseminated encephalomyelitis, and causes of encephalomyelitis such as influenza A, mumps, varicella zoster, adenovirus and E. coli, have been considered as etiologies but could be identified in only a few patients [3]. Important etiological causes of splenial lesions in peripartum cases are sinus vein thrombosis, post-ictal state and preeclampsia–eclampsia. Curtis et al. reported a splenial lesion in a patient with visual symptoms for 6 weeks in the postpartum period [4]. Udaya et al. described a splenial lesion in a patient with postpartum psychosis [5]. Our patient did not have any symptoms other than headache, nausea and vomiting. In conclusion, clinicians should consider RESLES in patients presenting with peripartum headache, even in the absence of visual symptoms or psychosis. & Aysegul Altunkas aaltunkas@hotmail.com

The evaluation of abdominal findings in Crimean-Congo hemorrhagic fever

ObjectiveCrimean-Congo hemorrhagic fever (CCHF) is a widely seen, fatal disease and is endemic to some countries. It affects many organs in the abdomen. Comprehensive radiological study of CCHF is quite rare. This study will use multiple detector computed tomography (MDCT) to investigate if there is a relationship between clinical laboratory measurements and abdominal findings in CCHF and discuss our findings in the light of the literature.Materials and methodsWe retrospectively evaluated the medical records of 443 patients diagnosed with CCHF in our hospital between April 1, 2008 and September 30, 2014. Fifty-one patients had undergone abdominal MDCT examination.ResultsThe most common findings seen in abdominal MDCT were intra-abdominal free fluid and hepatomegaly. Gallbladder wall thickening, heterogeneity in mesenteric, omental fatty tissue, and splenomegaly were other common findings. Subcutaneous fat tissue edema, intramuscular hemorrhage, duodenal wall thickening, colon wall thickening, pancreatitis, and acute renal failure were among the rare findings seen in abdominal MDCT. Comparison of these findings to the clinical laboratory parameters showed a strong relationship between intra-abdominal free fluid and platelet count.ConclusionOur study is the first comprehensive study on abdominal MDCT findings of CCHF. We detected a strong relationship between patients’ platelet count and abdominal free liquid. Therefore, it should be kept in mind that abdominal free fluid can be among clinical manifestations in patients with platelet counts ≤50000 and that this manifestation can become aggravated.

Pulmonary involvement in ankylosing spondylitis assessed by multidetector computed tomography

Summary Background Ankylosing spondylitis (AS) may present with extra-articular involvement in the lungs. We aimed to evaluate the abnormal pulmonary multidetector computed tomography findings of patients with AS and compare them with the clinical symptoms, duration of illness, laboratory results and pulmonary function tests (PFT). Material/Methods We evaluated the chest multidetector computed tomography (MDCT) findings of 41 patients with ankylosing spondylitis (AS) and compared them with pulmonary function test (PFT) results, demographic characteristics, duration of illness and laboratory findings that we were able to obtain. Results The most common abnormalities were nodules, peribronchial thickening, pleural thickening and bronchiectasis. Abnormalities occurred in 96.87% of patients in the early AS group and 77.8% of patients in the late AS group. Patients with early AS included asymptomatic individuals with normal PFT results and abnormal MDCT findings. Conclusions The use of MDCT in AS patients may be beneficial for the evaluation of pulmonary disease, even in asymptomatic patients without any PFT abnormalities and those in the early stages of the disease.

Ultrasound measurement of liver longitudinal length in a North Anatolian population: A community-based study

Background: Liver size can be influenced by various factors, including malignant diseases, infective processes, and anthropometric variations among individuals from different geographical locations and races. Therefore, the exact definition of hepatomegaly in the ultrasonographic measurement of liver size is controversial. Moreover, the majority of studies regarding the study of liver size are not community-based. Aims: The aim of this study is to establish a range of normal liver sizes by ultrasonography with respect to age and sex in healthy individuals and to identify factors affecting liver size. Study Design: This was a prospective, community-based study. Methods: Liver size was measured ultrasonographically from the midclavicular line in 822 individuals, of which 49.3% (n = 405) were male and 51.7% (n = 417) were female. Following physical examination, all participants provided blood samples. Height, weight, and waist circumference were recorded. The mean liver length was calculated for males, females, and for the whole study group. It was also determined whether there was an association between liver size and age, weight, height, body mass index (BMI), body surface area, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) enzyme levels. Results: The mean liver length was significantly different between males (150.04 ± 14.84) and females (147.57 ± 18.32, P = 0.034). Weight and BMI were the most strongly associated with liver size. There was a significant difference between liver size in individuals with normal and elevated levels of AST and ALT enzymes (P < 0.01). Conclusion: In a northern Anatolian Turkish population, liver size was greater among males than females. In light of these data, we believe our study may serve as a reference source for the evaluation of liver size.

A Comparison of Ultrasonography, Computerised Tomography, and Conventional MRI Findings for Splenic Nodules Associated with Type 1 Gaucher’s Disease with Diffusion-Weighted MRI Findings

A 26-year-old female patient with Type 1 Gauchers disease (GD) was admitted to our clinic with complaints of stomachache and signs of anemia. The patient underwent ultrasonography (US), computerised tomography (CT), and magnetic resonance imaging (MRI) scan. Imaging studies revealed massive hepatosplenomegaly, choledocolithiasis, and six nodules in the spleen with a mean size of 14 mm. The nodules appeared hyperechoic, hypoechoic, and of mixed echogenicity on the US and hypodense on the CT. While the nodules were observed to be iso-hypointense in T1-weighted (T1WI) images, they appeared to be hyperintense in the T2-weighted (T2WI) images. There were no diffusion restrictions in these nodules that appeared on the diffusion-weighted magnetic resonance imaging (DWI). A nodule located at the lower pole was observed to be hypointense in the T2WI images. The nodule located at the lower pole, which appeared hypointense in T2WI series, had restricted diffusion upon DWI. In this study, we aimed to present the properties of splenic GD nodules using US, CT, and conventional MRI, together with DWI. This case report is the first to apply US, CT, and conventional MRI, together with DWI, to the splenic nodules associated with Gauchers disease.

Is hemorrhage the reason in crimean-congo hemorrhagic fever patients with neurological signs and symptomsa

Purpose: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease can result in mortality varying from 3.0% to 50.0%. In this study, we wished to discuss computed tomography (CT) findings together with clinical and laboratory findings in patients who had disease-related neurological signs. Materials and Methods: The study included patients who were diagnosed with CCHF. Seventeen patients that had neurological signs were enrolled as the patient group. As a control group, 40 patients diagnosed with CCHF and did not have neurological signs were enrolled. Patients who had neurological signs were examined with brain CT. Radiological and clinical findings of both groups were compared. Results: There were pathological findings in three patients while brain CTs of 14 patients were evaluated as normal. Blood urea nitrogen, lactate dehydrogenase, creatine kinase, total bilirubin, neutrophil, activated partial thromboplastin time, and C-reactive protein levels were significantly higher in the group with neurological signs whereas platelet count and calcium levels were significantly lower in this group. Six of 57 patients died during the follow-up period. Six patients who died were in the group, in which central nervous system (CNS) imaging study was performed. Conclusion: As the presence of CNS signs is a bad prognostic indicator in CCHF, they should be investigated carefully.