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Objective To determine the relationship between arterial distensibility and hypothyroidism by simultaneous assessment of coronary angiography and aortic distensibility, measured using 128-slice retrospective electrocardiogram-gated multiple row detector computed tomography (MDCT). Methods Untreated hypothyroid patients and age-matched euthyroid patients, who underwent 128-slice retrospective electrocardiogram-gated MDCT to evaluate the coronary arteries, were assessed. Intraluminal aortic areas in systolic and diastolic phases of the cardiac cycle were measured with multiphase reformation at predefined locations including the ascending aorta, proximal descending aorta and distal descending aorta in the widest axial plane. Results The study included 21 hypothyroid and 21 euthyroid patients. Patients with hypothyroidism exhibited decreased aortic distensibility between each location in the thoracic aorta (ascending aorta, proximal descending aorta and distal descending aorta) compared with euthryoid patients. Conclusions Hypothyroidism was associated with preclinical vascular alteration, characterized by impaired aortic distensibility at each location of the thoracic aorta, which has been shown to be related to increased cardiovascular risk. Monitoring of aortic distensibility is relevant for evaluating coronary artery disease progression and treatment choices.

The aim of this study was to examine the structural-neurochemical abnormalities of the frontal white matter (FWM), deep gray matter nuclei, and pons in patients with Wilson's disease (WD) using proton magnetic resonance spectroscopy (MRS) and diffusion-weighted imaging (DWI). Nine patients with WD and 14 age-matched controls were examined with MRS. N-Acetylaspartate (NAA), choline (Cho), and creatine (Cr) peaks were calculated. DWI scans from six WD patients and six controls were also obtained. The relative metabolite ratios and apparent diffusion coefficient (ADC) values of the WD patients were compared to those of the control subjects by using statistical measures. Measurements in the thalamus and pons showed significantly lower NAA/Cho and NAA/Cr ratios in the WD group than in the control group (P < 0.05). Thalamic and pontine Cho/Cr ratios in the patient group were significantly higher than those of the control group (P < 0.05). No statistically significant relation was found between the patient and control groups as a result of the MRS examinations of FWM and all ADC measurements (P > 0.05). MRS is a noninvasive, valuable modality for detecting structural-neurochemical changes of the brain stem and deep gray matter in patients with WD. The contribution of DWI in these patients is limited.

Vertebrobasilar junction fenestration is a rare congenital anomaly which is commonly seen with an aneurysm formation. Because of the complex anatomical structure of this area complicates the surgical intervention, endovascular coil treatment of aneurysm is an alternative method. Several fenestration-related aneurysms may not be detected by 2D conventional angiography imaging due to their considerably thin and short structure or small size. By 3D rotational digital subtraction angiography, small-sized fenestrations can be examined at the intended plane from various angles. This method enables us to plan the endovascular intervention in detail by revealing orientation, neck, origin of perforator arteries, and the relation between aneurysm and fenestration. In the present case, we present the angiographic results of the case with vertebrobasilar junction fenestration, along with endovascular treatment of the ruptured aneurysm. Vertebrobasilar bileşke fenestrasyonu nadir bir konjenital anomalidir ve anevrizma formasyonuyla birlikte sıktır. Bu bölgenin kompleks anatomisi nedeniyle cerrahi müdahale zor olduğundan, anevrizmanın endovasküler coil tedavisi alternatif bir metoddur. Bazı fenestrasyonların çok ince ve kısa olması ve bazı anevrizmaların küçük olması nedeniyle iki boyutlu konvansiyonel anjiografi görüntülerinde saptanamayabilir. 3D rotasyonel dijital subtraksiyon angiografi ile küçük boyutlardaki fenestrasyonların ve anevrizmaların istenilen düzlemde, değişik açılarda incelenebilmesi mümkün olmaktadır. Anevrizmanın oryantasyonu, boynu, perforan arterlerin orjini ve anevrizma ile fenestrasyon ilişkisi gösterilerek endovasküler girişimin planmasına olanak sağlar. Biz bu yazıda vertebrobaziler bileşke fenestrasyonlu olgunun anjiografik bulguları ve rüptüre olmuş anevrizmanın endovasküler tedavisini sunmaktayız.

Purpose: To investigate neuronal dysfunction in the thalami of juvenile myoclonic epilepsy (JME) by using proton magnetic resonance spectroscopy (MRS). Methods: We performed single-voxel proton MRS over the right and the left thalami of 15 consecutive patients (10 women, 5 men) with JME (mean age 20.3 years) and 16 healthy volunteers (10 women, 6 men) (mean age 24.5 years). All patients had seizure onset in late childhood-teenage, normal neurologic examination, typical electroencephalogram (EEG) of JME and normal magnetic resonance imaging (MRI). We determined N-acetylaspartate (NAA) values and NAA over creatine-phosphocreatine (Cr) values. Mann-Whitney U-test was used to evaluate group differences. Results: Group analysis showed that echo time (TE) 270 integral value of NAA over left thalamus were significantly decreased in JME patients as compared with controls (34.6033 +/- 15.8386; 48.0362 +/- 22.2407, respectively, P = 0.019). Also group analysis showed that thalami NAA/Cr ratios were significantly decreased in JME patients (right side, 2.21 +/- 1.07; left side 2.00 +/- 0.72) as compared with controls (right side, 3.45 +/- 1.50; left side, 3.08. +/- 1.60; P = 0.011 and P = 0.030, respectively). Conclusion: In the previous studies, NAA values inpatients with JME found that they were not statistically lower in thalami than control group. But, in our study, NAA value was found tow as well. It has been known that NAA is a neuronal marker and hence it is a valuable metabolite in the neuron physiopathology. As a result, in the patients with JME we tried to support the theory that the underlying mechanism of the generalized seizures was the abnormal thalamocortical circuity, determining the thalamic neuronal dysfunction in MRS statistically.

Transient focal lesions of splenium of corpus callosum can be seen as a component of many central nervous system diseases, including antiepileptic drug toxicity. The conventional magnetic resonance (MR) findings of the disease are characteristic and include ovoid lesions with high signal intensity at T2-weighted MRI. Limited information exists about the diffusion-weighted MRI characteristics of these lesions vanishing completely after a period of time. We examined the conventional, FLAIR, and diffusion-weighted MR images of a patient complaining of depressive mood and anxiety disorder after 1 year receiving antiepileptic medication.

Summary Purpose To compare the diagnostic efficacies of phase-contrast MRI (PC-MRI) and three-dimensional constructive interference in steady-state (3D-CISS) sequence for the detection of spontaneous third ventriculostomy (STV) on the basis of contrast-enhanced MR cisternography (MRC). Patients and methods Eleven obstructive hydrocephalus patients with clinically-radiologically suspected STV and ten controls were examined by PC-MRI, 3D-CISS and MRC. PC-MRI and 3D-CISS sequence were applied to view the third ventricle and basal cisterns. Following injection of 0.5-1 ml intrathecal Gd-DTPA injection, postcontrast MRC images were obtained in three planes. Presence of STV was scored as follows: grade 0, no existence of STV; grade 1, STV present. Results of PC-MRI and 3D-CISS were compared with the MRC findings. Results In PC-MRI, five patients were assessed as grade 0 and six cases grade 1. As a result of 3D-CISS sequence, eight cases were evaluated as grade 0 and three cases grade 1. Based on MRC, nine cases were assessed as grade 0 and two cases grade 1. False positivity was found in four cases by PC-MRI and in one case by 3D-CISS. The sensitivity, specificity and accuracy of PC-MRI and 3D-CISS sequence regarding demonstration of STV, were 100, 100, 56, 89, 64, and 91% respectively. Discussion PC-MRI and 3D-CISS are helpful in confirming the STV. PC-MRI and 3D-CISS should be the first preference. If PC-MRI and 3D-CISS give negative results, then MRC is not required. MRC should be performed on patients who demonstrate suspected STV findings on PC-MRI and 3D-CISS sequences. MRC may prevent false positive results.

The aim of this prospective study was to evaluate the value of unenhanced (three-dimensional constructive interference in steady state (3D-CISS)) and contrast-enhanced MR cisternography (CE-MRC) in detecting the localisation of cerebrospinal fluid (CSF) leak in patients with rhinorrhoea. 17 patients with active or suspected CSF rhinorrhoea were included in the study. 3D-CISS sequences in coronal and sagittal planes and fat-suppressed T-1-weighted spin-echo sequences in three planes before and after intrathecal contrast media adminstration were obtained. Images were obtained of the cribriform plate and sphenoid sinus. In addition, high-resolution CT (HRCT) was performed in order to evaluate the bony elements. The leak was present in 9/17 patients with 3D-CISS and 10/17 patients with CE-MRC. The leak from the cribriform plate to the nasal cavity in six patients and from the sphenoid sinus in four patients was nicely shown by CE-MRC. Eight of those patients were surgically treated, but spontaneous regression of the symptoms in two precluded any intervention. The leak localisations shown with CE-MRC were fully compatible with surgical results. The sensitivities of HRCT, 3D-CISS and CE-MRC for showing CSF leakage were 88%, 76% and 100%, respectively. In conclusion, 3D-CISS is a non-invasive and reliable technique, and should be the first-choice method to localise CSF leak. CE-MRC is helpful in conditions when there is no leak or in complicated cases with a positive beta 2-transferrin measurement.

Rationale and Objectives: In this prospective study, we aimed to reveal the efficiency of phase-contrast magnetic resonance imaging (PC-MRI) in the diagnosis of idiopathic normal pressure hydrocephalus (INPH) and prediction of shunt response. Materials and Methods: The study group consisted of 43 patients with INPH diagnosis and 15 asymptomatic age-matched controls. PC-MRI studies were applied on cerebral aqueduct and superior sagittal sinus (SSS) in all the cases. Results: The maximum and mean cerebrospinal fluid (CSF) flow velocities were significantly higher in the INPH patients compared with the controls (P < .05). CSF stroke volume (43.2 +/- 63.8 mu L) and output/min (3921 +/- 5668 mu L) were remarkably higher in the NPH group compared with the control group (3.9 +/- 3.9 mu L, 439 +/- 487 mu L, respectively) (P < .05). Maximum and mean venous velocity values of the INPH patients (maximum, 19.2 +/- 4.3 cm/s; mean, 16 +/- 3.7 cm/s), were lower than those of the control group (maximum, 21.8 +/- 4.6 cm/s; mean, 18.9 +/- 3.9 cm/s) (P < .05). Stroke volume and venous output/min values of INPH patients in SSS, were significantly lower than those of the control group (P .05). Conclusion: The measurement of CSF venous flow velocities with PC-MRI is a noninvasive test that benefits INPH diagnosis, but remains inadequate in prediction of response against shunt treatment.

In the current study, we aimed to compare the diagnostic efficacies of phase-contrast magnetic resonance imaging (PC-MRI) and three-dimensional constructive interference in steady-state (3D-CISS) sequence over detection of aqueductal stenosis (AS) on the basis of contrast-enhanced magnetic resonance cisternography (MRC). Twenty-five patients with clinically and radiologically suspected AS were examined by PC-MRI, 3D-CISS, and MRC. Axial-sagittal PC-MRI and sagittal 3D-CISS were applied to view the cerebral aqueduct. Following injection of 0.5-1 ml intrathecal gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) injection, postcontrast MRC images were obtained in three planes in early and late phases. Aqueductal patency was scored as follows: grade 0, normal; grade 1, partial narrowing; and grade 2, complete obstruction. Results of PC-MRI and 3D-CISS were compared with the findings of MRC. In PC-MRI, seven cases were assessed as grade 0, 16 cases grade 1, and two cases grade 2. As a result of 3D-CISS sequence, eight cases were evaluated as grade 0, 12 cases grade 1, and five cases grade 2. Based on MRC, nine cases were assessed as grade 0, whereas nine and seven cases were evaluated to be grades 1 and 2, respectively. Five cases that demonstrated partial patency in PC-MRI or 3D-CISS showed complete obstruction by MRC. PC-MRI is helpful in confirming the AS. However, positive flow does not necessarily exclude the existence of AS. 3D-CISS sequence provides excellent cerebrospinal fluid-to-aqueduct contrast, allowing detailed study of the anatomic features of the aqueduct. MRC should be performed on patients who demonstrate suspected AS findings on PC-MRI and/or 3D-CISS sequences.

AIM: To evaluate the value of morphometric analysis and perfusion-weighted magnetic resonance imaging (MRI) in differentiating solitary metastases from high-grade gliomas. MATERIALS AND METHODS: Forty-eight tumours (22 high-grade gliomas and 26 solitary hemispheric metastases) were evaluated using conventional and perfusion-weighted MRI. T2-weighted, gradient-echo, echo-planar sequences were used for perfusion-weighted MRI. Relative cerebral blood volume (rCBV) ratios were calculated by dividing the rCBV of the intratumoural and peritumoural areas with the average CBV value of the normal white matter areas. Morphometric analysis was carried out by proportioning the area of peritumoural oedema to the mass area. Mann-Whitney U test and ROC Curve analysis were applied for statistical analysis. P < 0.05 was accepted as statistically significant. RESULTS: Mean rCBV ratios of intratumoural areas of high-grade gliomas and metastases were 5.02 +/- 2.47 and 4.62 +/- 2.46, respectively. No statistically significant difference was found (p = 0.515). rCBV ratios of peritumoural oedema were 0.89 +/- 0.51 in high-grade gliomas and 0.31 +/- 0.12 in metastases. The difference was statistically significant (p < 0.001). According to the results of morphometric analysis, a statistically significant difference was present between the two tumour types (p < 0.001). CONCLUSION: Measuring the oedema: mass and rCBV ratios of the oedema surrounding the tumour prior to operation in solitary masses proved to be useful for differentiating metastases from high-grade gliomas.

The objective of this study was to evaluate the role of phase-contrast cine magnetic resonance imaging (PC-MRI) in detecting possible communications between intraventricular arachnoid cysts (IV-ACs) and cerebrospinal fluid (CSF) spaces based on MR cisternography (MRC) comparison. Twenty-one patients with IV-AC were examined by PC-MRI and MRC. In order to determine the communication of IVAC with its neighbouring CSF spaces, PC-MRI was employed. The communication of IV-ACs with the ventricular system was examined on at least two anatomic planes. Precontrast images and PC-MRI were followed by the intrathecal administration of 0.5-1 ml gadopentetate dimeglumine. Early and delayed MRC were then carried out. Results of PC-MRI were compared with findings of MRC (McNemar's test). In seven IV-ACs, no communication was detected by PC-MRI. In 14 IVACs, a pulsatile CSF flow into the IV-ACs was observed. All the IV-ACs, which have been determined as non-communicating (NC) on the PC-MRI, showed NC character on MRC as well. Six cases suggesting a communication on PC-MRI showed no communication on MRC. MRC revealed eight communicating (38%) and 13 NC (62%) IV-ACs among a total of 21 cases. The sensitivity and specificity of PC-MRI imaging in demonstrating the communication between the IV-ACs and the CSF were 100% and 54%, respectively. PC-MRI is an effective method for evaluating NC IV-ACs. In order to decide about the management of IV-ACs, which are communicating according to the PC-MRI, the results should be confirmed with MRC if suspected jet flow is depicted.

Purpose: The aims of the study are firstly, to determine the difference in diffusion-weighted imaging (DWI) in normal appearing white matter (NAWM) between patients with acute multiple sclerosis (MS) and controls; secondly, to determine whether there is a correlation between EDSS scores and DWI in acute plaques and also NAWM. Materials and method: Out of 50 patients with acute MS attack, 35 patients had active plaques with diffuse or ring enhancement on postcontrast images. Eighteen healthy volunteers constituted the control group. While 26 of 35 had relapsing-remitting, 9 had secondary progressive MS. Apparent diffusion coefficients (ADC) of the active plaques, NAWM at the level of centrum semiovale and occipital horn of lateral ventricle in the patients and NAWM in control group were measured. ADC values of active plaques were compared with WM of the patients and the control group. The relationship of ADC value of active plaques and WM in MS with expanded disability status scale (EDSS) was investigated by using Mann-Whitney U-test. Results: Of 63 plaques totally, 26 and 37 of the active plaques had diffuse and ring enhancement, respectively. There was no statistically significant difference between ADC value of active plaques and EDSS (p > 0.05). However, there was a statistically significant difference between ADC value of WM occipital horn and EDSS (p < 0.05). ADC value of active plaques were higher than WM in both groups (p < 0.001). The difference between ADC value of WM at the centrum semiovale (p < 0.05) and occipital horns (p < 0.001) in patients and controls was statistically significant. There was no statistically significant difference between EDSS scores, ADC value at centrum semiovale and WM around occipital horn and active plaques in subgroups (p > 0.05). Conclusion: Apparently normal tissue in MS patients may show early abnormalities when investigated carefully enough, and there is an even though moderate correlation between EDSS and ADC values and early alterations of ADC value are starting in the occipital white matter along the ventricles. This has to be verified in larger series.

Introduction: Atypical/malignant meningiomas recur more frequently then typical meningiomas. In this study, the contribution of diffusion-weighted MR imaging to the differentiation of atypical/malignant and typical meningiomas and to the determination of histological subtypes of typical meningiomas was investigated. Methods: The study was performed prospectively on 39 patients. The signal intensity of the lesions was evaluated on trace and apparent diffusion coefficient (ADC) images. ADC values were measured in the lesions and peritumoral edema. Student's t-test was used for statistical analysis. P < 0.05 was considered statistically significant. Results: Mean ADC values in atypical/malignant and typical meningiomas were 0.75 +/- 0.21 and 1.17 +/- 0.21, respectively. Mean ADC values for subtypes of typical meningiomas were as follows: meningothelial, 1.09 +/- 0.20; transitional, 1.19 +/- 0.07; fibroblastic, 1.29 +/- 0.28; and angiomatous, 1.48 +/- 0.10. Normal white matter was 0.91 +/- 0.10. ADC values of typical meningiomas and atypical/malignant meningiomas significantly differed (P < 0.001). However, the difference between peritumoral edema ADC values was not significant (P > 0.05). Furthermore, the difference between the subtypes of typical meningiomas and atypical/malignant meningiomas was significant (P < 0.001). Conclusion: Diffusion-weighted MR imaging findings of atypical/malignant meningiomas and typical meningiomas differ. Atypical/malignant meningiomas have lower intratumoral ADC values than typical meningiomas. Mean ADC values for peritumoral edema do not differ between typical and atypical meningiomas.

Polyarteritis nodosa is a multisystem disease primarily involving the small and medium-sized vessels. Prognosis depends on the presence and severity of visceral involvement. Thrombosis and aneurysm formation commonly occur in kidney and gastrointestinal tract. Although hepatic involvement is also common, hepatic aneurysmal rupture with intrahepatic or perihepatic hematoma formation is infrequent. Hemobilia secondary to aneurysmal rupture is a very rare condition. We present a case of polyarteritis nodosa accompanied by hemobilia and intestinal hemorrhage secondary to hepatic and mesenteric aneurysmal rupture.

Introduction To investigate the contribution of perfusion-weighted MRI to the differentiation of meningiomas with atypical conventional MRI findings from intraaxial tumors. Methods We retrospectively analyzed 54 meningiomas, 12 glioblastomas and 13 solitary metastases. We detected 6 meningiomas with atypical features on conventional MRI resembling intraaxial tumors. The regional cerebral blood flow (rCBV) ratios of all tumors were calculated via perfusion-weighted MRI. The signal intensity-time curves were plotted and three different curve patterns were observed. The type 1 curve resembled normal brain parenchyma or the postenhancement part was minimally below the baseline, the type 2 curve was similar to the type 1 curve but with the postenhancement part above the baseline, and the type 3 curve had the postenhancement part below the baseline accompanied by widening of the curve. Student's t-test was used for statistical analysis. Results On CBV images meningiomas were hypervascular and the mean rCBV ratio was 10.58 +/- 2.00. For glioblastomas and metastatic lesions, the rCBV ratios were 5.02 +/- 1.40 and 4.68 +/- 1.54, respectively. There was a statistically significant difference in rCBV ratios between meningiomas and glioblastomas and metastases (P < 0.001). Only one of the meningiomas displayed a type 2 curve while five showed a type 3 curve. Glioblastomas and metastases displayed either a type 1 or a type 2 curve. None of the meningiomas showed a type 1 curve and none of the glioblastomas or metastases showed a type 3 curve. Conclusion Differentiating meningiomas with atypical conventional MRI findings from malignant intraaxial tumors can be difficult. Calculation of rCBV ratios and construction of signal intensity-time curves may contribute to the differentiation of meningiomas from intraaxial tumors.

In some instances conventional imaging techniques fail to differentiate meningiomas from isolated dural metastasis. This study aimed to evaluate the role of diffusion and perfusion-weighted MRI in differentiating meningiomas and dural metastasis. In this study, 14 metastasis and 26 meningiomas were involved. The imaging characteristics were analyzed using conventional MRI. Diffusion-weighted MRI was performed and ADC values were calculated from the solid components and the peritumoral edema. Perfusion-weighted MRI was performed and relative cerebral blood volume (rCBV) was calculated. Student's t test was used for the statistical analysis. Dural metastasis and meningiomas could not be differentiated by qualitative assessment of conventional and diffusion-weighted MRI. The mean intratumoral and peritumoral ADC values were not statistically significant (p > 0.05). The rCBV ratios for dural metastasis and meningiomas were 4.13 ± 2.32 and 7.32 ± 4.10 respectively and the difference between two was statistically significant (p = 0.003). Peritumoral rCBV ratios for dural metastasis and meningiomas were not statistically significant (p > 0.05). Conventional MRI findings of dural metastasis and meningiomas may overlap in some lesions. In differentiation of these lesions diffusion-weighted MRI yields no further information additional to conventional sequences. Perfusion-weighted MRI can be useful to distinguish these lesions by demonstrating high intratumoral rCBV ratios for meningiomas and low rCBV ratios for metastasis.

Purpose: The goals of this work were to measure the apparent diffusion coefficients (ADCs) for both hippocampus and amygdala of persons diagnosed with temporal lobe epilepsy (TLE) and unilateral hippocampus pathology on magnetic resonance imaging and to evaluate the sensitivity of diffusion-weighted (DW) images in determination of the lateralization of the epileptogenic focus. Methods: Thirteen cases with a TLE diagnosis and 21 healthy subjects were evaluated. Fluid-attenuated inversion recovery and T2W images of TLE cases revealed hippocampal volume loss and signal intensity changes. DW images were obtained by spin-echo echo-planar sequences vertical to the hippocampal axis. Qualitative and quantitative ADCs for left and right hippocampus and the amygdala of the controls and the patients were determined. Hippocampal ADCs were obtained independently at the head, body, and tail levels of the hippocampus. Statistical evaluation was conducted with Kruskal–Wallis and Mann–Whitney U tests. Predictive cutoff levels of hippocampal ADCs for identifying pathologic areas were established through receiver operating characteristic (ROC) curve analysis. Result On conventional images, 5 of 13 cases had right hippocampal pathology, and 8 of 13 cases had left hippocampal pathology. There were no bilateral hippocampal changes in signal intensity and no cases with bilateral atrophy. The amygdala was normal in all patients except one case of hyperintense signals. No statistical differences were found between the hippocampal and amygdaloid ADCs of the control subjects (P > 0.05). However, there was a significant difference between the ADCs for the side with hippocampal pathology and the ADCs for the contralateral side, and the control group (P < 0.001). No statistical difference was detected for the amygdala (P > 0.05). Hippocampal and amygdaloid ADCs of the contralateral lesion and the values of the control group were not statistically significantly different (P > 0.05). ROC curve analysis indicated 136 as the best cutoff level for hippocampal pathology. Conclusion DW trace images are insensitive in lateralization of hippocampal pathology; however, lateralization can be achieved through ADC measurements of the hippocampus. An increase in ADC on the affected side should be considered as indicating pathology. On the other hand, amygdaloid ADC values remain inaccurate.

Solid and papillary epithelial neoplasm of the pancreas is a very rare low-grade malignant neoplasm with only 126 cases reported in the literature and seen mostly in young female patients. Surgical excision means cure in cases before malignant degeneration developed. Its characteristic findings are typical location in the tail of the pancreas, peripheral capsule formation, hypodensity on CT images, and hyperintense internal signal characteristics on T1-weighted MR images secondary to hemorrhage and accumulation of methemoglobine molecule. These findings are enough for the preoperative diagnosis that may lead to early surgery and cure. We present the CT and MR findings of this very rare neoplasm in a case report.

Objective: Brucellar spondylitis is one of the most serious complications of brucellosis. It should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas such as Turkey. This report describes important features of the disease. Methods: Twenty-five patients with brucellar spordylitis were retrospectively evaluated in terms of their clinical, laboratory, and radiologic features and their response to different treatment regimens. Results: The most common symptoms of brucellar spondylitis were back pain, fever, and sweating. Rose Bengal tests were positive in all of these patients. Brucella species was isolated from blood cultures of 8 (32%) patients. Magnetic resonance imaging (MRI) showed that the lumbar segment was the most frequently involved region. Different combination regimens including 2 or 3 antibiotics were used. Combination of tetracycline (especially doxycycline) and streptomycin was the most widely used therapy regimen. Trimethoprim-sulfamethoxazole, ciprofloxacin, ofloxacin, and rifampin were also included in some combination therapies. In this series, the mean duration of antimicrobial therapy was 130 +/- 45.6 days (range, 77-281 days), and 92% of patients received therapy for greater than or equal to 90 days. There were no mortalities in this study. Conclusions: Brucellar spondylitis should be considered in patients with back pain and neurologic disorders as well as systemic symptoms and findings in endemic areas. MR imaging is recommended in suspected cases. The patients can be treated effectively treated with appropriate antibiotic combinations. Follow up is important because relapses can occur.

Objective: To investigate the effectiveness of low-level laser therapy in the treatment of temporomandibular disorder and to compare treatment effects in myogenic and arthrogenic cases. Methods: Thirty-five patients were evaluated by magnetic resonance imaging and randomly allocated to active treatment (n=20) and placebo treatment (n = 15) groups. In addition to a daily exercise program, all patients were treated with fifteen sessions of low-level laser therapy. Pain, joint motion, number of joint sounds and tender points were assessed. Results: Significant reduction in pain was observed in both active and placebo treatment groups. Active and passive maximum mouth opening, lateral motion, number of tender points were significantly improved only in the active treatment group. Treatment effects in myogenic and arthrogenic cases were similar. Conclusion: Low-level laser therapy can be considered as an alternative physical modality in the management of temporomandibular disorder.

Aims—To determine the eYcacy of dacryocystoplasty with balloon dilatation in the treatment of complete and partial obstruction of the lacrimal drainage system. Methods—The procedure was performed on 26 patients with epiphora due to complete (n=16) or partial (n=10) obstruction of the lacrimal drainage system. A flexible tipped guide wire was introduced through the superior canaliculus into the inferior meatus and manipulated out of the nasal cavity. A 3 mm balloon was then introduced in a retrograde direction over the guide wire and dilated at the obstruction site. Results—The procedure was technically successful in all patients with partial obstruction, but unsuccessful in four of 16 cases with complete obstruction. Reobstruction occurred in eight of 12 patients with complete obstruction, and in five of 10 patients with partial obstruction. The overall success rate was 25% for complete and 50% for partial obstructions. The mean follow up was 14 months (8‐37 months). Conclusion—Although the balloon dacryocystoplasty is a simple and minimally invasive technique, the outcome from our study indicates that it is not advisable for treatment of complete obstruction of the lacrimal drainage system. Balloon dilatation may prove suitable for the treatment of patients with partial obstruction below the level of the lacrimal sac, especially in those who are poor candidates for surgery, or who do not wish to undertake dacryocystorhinostomy. Even in the partial obstruction group the success rate was only 50%, so that further modification to the technique and controlled studies are likely to be required before it could be recommended for general use. (Br J Ophthalmol 1999;83:692‐696)

Cerebral hydatid cysts account for 2% of all intracranial masses. Preoperative diagnosis is important since cyst rupture and spillage may cause an anaphylactic reaction. CT is the primary modality for the diagnosis. Two forms of cerebral hydatid cysts have been reported on the basis of CT appearances: unilocular and multilocular. Demonstration of the cyst wall is important for the diagnosis. MRI is superior to CT for demonstrating the cyst capsule and perifocal oedema. We retrospectively reviewed the CT and MRI findings of 6 surgically proven cases of cerebral hydatid cyst and compared the two modalities on the basis of their demonstration of findings helpful in the diagnosis, such as the capsule and perifocal oedema. In 1 case CT showed the capsule. In 2 cases MRI showed a hypointense capsule around the cyst on T2-weighted images. While CT is the modality of choice, in clinical practice MRI is superior for demonstrating the cyst capsule, which is a helpful finding in the diagnosis and can be used in inconclusive cases.