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A newnborn admitted to NICU showed a severe clinical profile

The following pages shall demonstrate how the nature of things is made evident through the science of naming, the structure of designation. Through this extensive analysis, I aim at establishing the connection between Greek mythology and modern cardiology by exploring the origin of the word echography and its modern counterpart the Doppler echography.

SUMMARY: Brucellosis is an endemic disease in various regions of the world. Testicular abscess is a very rare complication of brucellosis which can be misdiagnosed as a testicular mass and may lead to unnecessary orchiectomy. To our knowledge there are only eight reported cases in the literature of a brucellar testicular abscess. We present a case of testicular abscess due to brucellosis diagnosed with serologic tests and color Doppler sonography, and treated with antibiotics and fine needle aspiration. Key words: Abscess, brucellosis, color Doppler sonography, testicular, ultrasonography

Background: Subclinical atrial stunning (AS) (left atrial dysfunction) may increase vulnerability to oxidative and inflammatory stressors, thus increasing the likelihood of postoperative supraventricular arrhythmias, especially atrial fibrillation (AF). Evaluation of mitral annular velocities by tissue Doppler imaging (TDI) may be useful in seeking subclinical AS. This prospective study aimed to evaluate the relationship between atrial fibrillation after bypass surgery and presurgical determination of subclinical AS by assessing mitral annular velocities by TDI. Methods: We enrolled patients who underwent coronary artery bypass graft (CABG) surgery into this prospective study. Inclusion criteria were sinus rhythm and a negative history of atrial tachycardia during the previous 3 mo. An experienced cardiologist performed transthoracic echocardiography in all patients. We recorded standard two-dimensional, mitral inflow conventional Doppler interrogation and TDI pulsed wave data from the lateral and septal annulus. All patients underwent CABG surgery at our Cardiovascular Surgery Unit. Patients were divided into two groups based on their postoperative AF status: group 1 patients had postoperative AF and group 2 patients did not. Results: This study included 44 patients. Age and the presence of chronic obstructive pulmonary disease were the only two significantly different parameters among clinical characteristics between groups. Echocardiographic findings that were statistically significantly different between groups were as follows: lateral A diastolic mitral annular velocity, group 1: 0.11 ± 0.19 ms-1 versus group 2: 0.08 ± 0.19 ms-1 (P = 0.001); lateral E diastolic mitral annular velocity, group 1: 0.69 ± 0.24 ms-1 versus group 2: 0.62 ± 0.31 ms-1 (P = 0.016); Septal E diastolic mitral annular velocity, group 1: 0.05 ± 0.01 ms-1 versus group 2: 0.04 ± 0.01 ms-1 (P = 0.033); septal A diastolic mitral annular velocity, group 1: 0.08 ± 0.02 ms-1 versus group 2: 0.05 ± 0.02 ms-1 (P = 0.005). Conclusions: There is no relationship between AF after CABG surgery and preexisting subclinical AS determined with mitral annular velocities by TDI. Preoperative appropriate prophylactic treatment should be administered to all patients. © 2012 Elsevier Inc. All rights reserved.

The information about the thromboembolic events, the optimal treatment choice, the dose, and duration of antithrombotic therapy in children are limited. More clinical data are required. Recombinant tissue plasminogen activator (r-tPA) is increasingly used in pediatric thrombosis. We retrospectively analyzed the clinical course of 7 children (9.3 ± 2.1 years; 34 days to 16 years) with arterial thrombosis (n = 1) and intracardiac thrombosis (n = 6). The children were treated with r-tPA. The dose ranged between 0.2 and 0.4 mg/kg per h infused for 3 to 4 hours. This dose was repeated between 2 to 7 times till the thrombolysis was achieved. Treatment side effects were closely monitored. Complete clot lysis was achieved in all cases. None of them had severe bleeding except mild recurrent epistaxis occurring in 2 cases. In conclusion, r-tPA is an effective and safe therapy under close hemostatic control in children.

Wandering spleen is the displacement of the spleen from its normal location due to the loss or weakening of ligaments that hold the spleen in the left upper quadrant. The possibility of torsion of the spleen is high due to the long and mobile nature of the vascular pedicle. Generally, cases are asymptomatic. Under conditions of delayed diagnosis, symptoms of splenomegaly, left portal hypertension, gastric fundal varices, and hypersplenism. may present as a result of development of vascular congestion associated with chronic torsion. There are only a few cases in the literature reporting the association of wandering spleen and fundal vat-ices. We report herein the case of a 55-year-old female who admitted to our clinic with complaints of fatigue and epigastric pain. She was determined to have gastric fundal varices and hypersplenism secondary to the development of left portal hypertension due to chronic splenic torsion.

Objective: To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules. Materials and Methods: We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values. Results: A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p < 0.05). The pattern of vascularity as determined by PDUS analysis was not a statistically significant criterion to suggest benign or malignant disease in this study (p > 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05). Conclusion: Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules.

Objectives: The aim was to determine the diagnostic value of a juxtaluminal black (hypoechoic) area without a visible echogenic cap (JBA) in ultrasonic images of internal carotid artery plaques. Methods: Ultrasonic images of plaques from 324 patients with asymptomatic (n = 139) and symptomatic (n = 185) internal carotid 50% to 99% stenosis in relation to the bulb (European Carotid Surgery Trial) referred for duplex scanning were studied. The JBA in mm2 and the gray-scale median (GSM) were obtained after image normalization. Cut-off points for GSM and JBA (combined highest sensitivity with highest specificity) were determined from receiver operator characteristic (ROC) curves. Results: JBA ≥ 8 mm2 was associated with a high prevalence of symptomatic plaques in all grades of stenosis. In a multiple logistic regression model, increasing stenosis (mild, moderate, severe), GSM ≤ 15 and JBA ≥ 8 mm2 were independent predictors of the presence of hemispheric symptoms. This model could identify a high-risk group of 188 plaques that contained 142 (77%) of the 185 symptomatic plaques (odds ratio [OR], 6.7 95% confidence interval [CI], 4.08-10.91), (P < .001), (sensitivity: 77% specificity 66% positive predictive value 75% negative predictive value 68%). Conclusions: The results of this study indicate the diagnostic value and for the first time suggest a cut-off point of 8 mm2 for JBA. This cut-off point needs to be validated in other groups and then applied to prospective studies of asymptomatic patients. © 2010 Society for Vascular Surgery. 52 1 69 76 Cited By :32

Objective: To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses. Materials and methods: Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria. Results: Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p < 0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p < 0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively. Conclusion: PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.

BACKGROUND Renal dysfunction is relatively common in patients with primary hypertension (PH). A reduction in coronary vasodilator capacity has recently been reported in patients with renal damage undergoing coronary angiography. We investigated the relationship between coronary flow reserve (CFR) and early renal abnormalities in patients with PH and normal serum creatinine. METHODS Seventy-six untreated patients were studied. Albuminuria was measured as the albumin-to-creatinine ratio and glomerular filtration rate (eGFR) was estimated by the Cockroft-Gault formula. Chronic kidney disease (CKD) was defined as an eGFR

Purpose. To report a case of branch retinal artery occlusion including the ophthalmic artery posterior to the optic disk following cataract surgery in a patient with bilateral internal carotid artery stenosis. Case report. A 75-year-old woman underwent phacoemulsification and intraocular lens implantation in her right eye. The surgery was uneventful. A month later, her vision of the operated eye decreased and an inferior altitudinal visual field defect was found, and ophthalmoscopy revealed two superior branch retinal artery occlusions. Fluorescein angiography showed extremely delayed infusion of the two arteries and the vessels in the disk. The single flash, rod-cone electroretinogram had a negative-type pattern. Magnetic resonance imaging angiography and Doppler echography demonstrated bilateral carotid artery stenosis. The avascular area of the retina was photocoagulated, and aspirin was prescribed. No further ocular complications occurred.

Aslan, Ahmet/0000-0003-1433-6149 WOS: 000334023600013 PubMed: 23979622 Lymphatic malformation (LM) is a localized and rare benign anomaly of the lymphatic system. Surgery is the primary form of treatment, but total resection is difficult and generally not possible. The least invasive and most effective form of treatment is injection sclerotherapy with sclerosing agents. Here, we report a case of LM in a baby, detected at prenatal ultrasound. The aim of this report is to assess the importance of ultrasonography in the prenatal diagnosis, therapy and follow-up of LM's.

The objective is to investigate the effect of obesity and hepatosteatosis on the Doppler waveform pattern of the hepatic veins. B-mode and duplex Doppler sonography of the liver and the right hepatic vein was performed in 102 obese subjects and 84 healthy volunteers. The severity of fatty infiltration was graded as mild, moderate and severe. The flow pattern of the right hepatic vein was classified as triphasic, biphasic and monophasic. The Doppler flow pattern in the right hepatic vein was triphasic in 56 (55%), biphasic in 27 (26%) and monophasic in 19 (19%) obese patients, whereas it was triphasic in 83 (99%) and biphasic in 1 (1%) control subject, achieving a statistical significance (Mann-Whitney U-test, P

The objective of our study was to determine the value of color Doppler imaging as an adjunct to gray-scale sonography to reveal the intra- or extraparotid origin of jugulodigastric nodules of uncertain location.Forty nodules in the jugulodigastric area from 38 patients were imaged with gray-scale, color, and power Doppler sonography. Nodules receiving vessels from salivary glands were assumed to be intraglandular; those accepting vessels from paraparotid spaces were considered to arise from outside the gland. Imaging results were correlated with biopsy and surgical findings.In 38 of 40 cases, color and power Doppler sonography displayed discrete feeding arteries leading to the nodules: 25 nodules had one supplying artery, nine received two arteries, and four had three or more arteries. Intraparotid nodules received vessels from the gland in 20 cases. In two cases, the source of vessels was indeterminate. In two malignant tumors, multiple arteries derived from both the parotid and the neck spaces. All 14 extraparotid nodules received the arterial supply from paraparotid spaces. Color Doppler sonography enabled prediction of the intraglandular location of the nodules in 91% of cases and the extraglandular location in 87.5% of cases. The correct diagnosis was achieved in 34 of 40 nodules, with a global accuracy of 85%.Color Doppler sonography can help to assess the intra- or extraparotid location of jugulodigastric nodules. In practice, this technique can support the diagnosis when gray-scale sonography raises doubts about the origin of a jugulodigastric nodule.

Doppler test objects are used to characterise Doppler systems, both stand-alone systems and the Doppler part of so-called duplex scanners. The aim of the project partially presented here is the development and validation of an example of a Doppler test object fulfilling the requirements of the IEC 1685. The project has been carried out by nine partners of five European countries and has been funded by the European Commission. The flow Doppler test object is composed of: tissue mimicking material (TMM), blood mimicking fluid (BMF), tube (embedded in the TMM and carrying the BMF), tank, flow system, including a pump and a flow meter. In the normative part of the IEC 1685, requirements are given for the values of acoustical parameters of TMM and BMF such as sound velocity, attenuation and backscattering. For BMF, requirements are given also for values of density and viscosity. In an informative (but not compulsory) annex, a description is given of a flow test object meeting these requirements as an example. This 'example test object' developed during the project is composed of TMM based on agar and including SiC-and Al2O3-powders, BMF based on nylon particles suspended in water and glycerine, and a tube of c-flex, a silicon copolymer. Two tube sizes are used: 4.0 mm ID and 8.0 mm ID. During the project, very precise recipes have been developed for the composition and preparation of both TMM and BMF. Based on these recipes and a description of the construction in a design five flow test objects have been constructed in the laboratories of five participants. The test objects have been compared by measurements of the physical parameters and by Doppler measurements of the five test objects with the same Doppler system. The measurements have been carried out by five observers. Inter-test object and inter-observer variabilities are determined, yielding information about usefulness of the parameters. © 1998 Elsevier Science B.V. Chemicals/CAS: Agar, 9002-18-0; Aluminum Oxide, 1344-28-1; Biocompatible Materials; C-Flex, 104521-01-9; Glycerol, 56-81-5; Nylons; Polyethylenes; Polystyrenes; Silicon, 7440-21-3

Vasospasm that develops in association with ergotamine use is a rarely seen but well-understood complication.A case is presented here of multiple fractures in which arteriospasm affecting all the arteries of the lower limb on the same side occurred 10 days posttrauma. In this case, the arteriospasm resulting from ergotamine addiction and high doses of ergotamine, which may be confused with post-traumatic angiospasm, was treated with a marcaine infusion by epidural catheter and heparin, iliomedin and nitronal infusion intravenously.This clinical condition should be borne in mind for all trauma cases determined to have arterial vasospasm, and the use of ergotamine must be queried when taking the anamnesis from the patient. Ergotamin kullanımına bağlı gelişen vazospazm nadir görülen ve iyi bilinen bir komplikasyondur. Bu yazıda çoklu kırığı olan ve travma sonrası 10. günde görülen ve aynı taraf alt ekstremitede tüm arterlerin etkilendiği arteriyospazm olgusu sunuldu. Bu olguda travma sonrası anjiyospazm ile karışabilecek olan ergotamin bağımlılığı ve aşırı doz egotamin kullanımı sonucu ortaya çıkan arteriyospazm; epidural kateter aracılığı ile marcain infüzyonu, intravenöz yolla heparin, iliomedin ve nitronal infüzyonu ile tedavi edildi. Tüm arteryel vazospazm saptanan travma olgularında bu klinik durum akılda tutulmalı ve hastadan anamnez alınırken ergotamin kullanımı mutlaka sorgulanmalıdır.

Backgrounds and aims: Paraoxonase 1 (PON1) is a novel marker that has been shown to exert protective functions on atherosclerosis by preventing oxidative modification of serum lipoproteins. In this study, we investigated the effects of PON1 on CA-IMT in renal transplant patients. Methods: A total of 98 adult renal transplant recipients was enrolled in the study. CA-IMT was determined by B-mode Doppler ultrasonography. PON1 activity was assessed by the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.4 ± 9.6 years and 10% of the patients were diabetic. Time after transplant was 76 ± 59 months. Mean PON1 level was 62.1 ± 43.3 U/l. PON1 levels were negatively correlated with CA-IMT and positively with HDLcholesterol. Mean CA-IMT was 0.62 ± 0.10 mm (0.40-0.98). CA-IMT was positively correlated with age, male gender and negatively with proteinuria and PON1 levels. In linear regression analysis, PON1 levels were associated with CA-IMT. Conclusion: Reduced PON1 activity is significantly associated with increased carotid atherosclerosis in renal transplant patients. © 2013 Dustri-Verlag Dr. K. Feistle.

Purpose: To present the authors' experience treating dural carotid-cavernous sinus fistulas (CCF) with retrograde embolization via the thrombosed superior ophthalmic vein (SOV). Methods: The medical records of 4 patients with dural CCFs treated via the thrombosed SOV were reviewed. All procedures were performed unilaterally in the interventional radiology unit with the administration of general anesthesia. The SOV was exposed via an eyelid crease incision, and then an angiocatheter was inserted in the vein and advanced through the segment with thrombosis to the cavernous sinus, where embolizing agents were deposited. After the procedure, the patients were followed up and evaluated clinically. Results: Three patients had unilateral CCFs, and 1 had a bilateral CCF (3 women and 1 man; age range, 58-68 years). The CCFs were Barrow type B (n = 2) and Barrow type D (n = 2). All patients had severe venous congestive orbital symptoms, chorioretinopathy, increased intraocular pressure, and visual loss. In all cases, the SOV appeared as a pale, thin, tortuous vessel adherent to the surrounding tissues during the surgical procedure. In 3 patients, the cavernous sinus was successfully embolized, and all symptoms were completely resolved without recurrence during follow up (3, 15, and 24 months). In the patient in whom the SOV could not be catheterized, the symptoms regressed slowly, but visual acuity remained unchanged during follow up (64 months). Conclusions: Dural CCFs can be successfully treated through the SOV, even when the vein is thrombosed. Identification and catheterization of the thrombosed SOV may be difficult because of the tiny and fibrotic structure of the vein.

ASCO (Atherosclerosis, Small vessel disease, Cardiac source, Other cause) is a new of classification of ischemic cerebrovascular diseases. This classification categorizes the data of the patients according to all underlying diseases and allows the clinician to grade the severity of cause (Each of the four phenotypes can be graded 1, 2, or 3). It is suggested to use ASCO classification in large epidemiologic studies but this classification may be used in daily practice. In this study we aimed to analyze the clinical features of patients with ischemic stroke and to investigate results of ASCO classification of these patients and data of 35 patients with ischemic stroke is analyzed. Use of ASCO classification is discussed with the special example cases. Patients' etiology of stroke was classified according to ASCO as known, unknown, completely unknown and unclassifiable group. Percentile of the patients classified as "known" was 71.4% (n = 25), "unknown" was 17.1% (n = 6), "completely unknown" was 5.7% (n = 2) and "unclassifiable group" was 5.7% (n = 2). We think that the ASCO classification which is thought to be more useful in large epidemiologic studies may be used in clinical follow-up period of the stroke patients. Further studies, from different neurology centers and stroke units, are needed to expand our experiences about use of ASCO classification in clinical practice.

Hydatid disease can be seen anywhere in the body and presents with a variety of clinical symptoms and imaging features according to its location. In this article, computed tomography features of a giant hepatic hydatid cyst extending into the right atrium and causing pulmonary embolism are presented. © 2012 Elsevier Inc.

Coexsisting ankylosing spondylitis (AS) and gouty arthritis have rarely been reported in the literature previously. We present a 43-year-old male patient with AS who had been diagnosed as having gout based on some clinical and laboratory findings. In this paper, the clinical features of both rheumatic diseases are discussed in light of the recent literature. The gouty arthritis should be considered in the differential diagnosis of acute peripheral arthritis in patients with AS. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing.

A 31-year-old woman with Youssef syndrome was reported. Vesicouterine fistula is responsible for the symptoms of Youssef syndrome. An easy and feasible diagnostic method of vesicouterine fistula is sonohysterography. © 2009 The International Urogynecological Association.

Objective: In this study, we investigated hyperhomocysteinemia, as well as carotid intima-media thickness (CIMT) measurements using carotid Doppler ultrasonography, in Parkinson patients on levodopa treatment. Methods: This study was carried out on 23 patients with Parkinson's disease and 21 age-and gender-matched healthy volunteers. Carotid Doppler ultrasonography was performed in order to determine CIMT in all cases. In addition, plasma homocysteine, vitamin B12 and folate levels were measured. Carotid Doppler ultrasonography and homocysteine levels were repeated one year later to evaluate the rate of atherosclerosis progression. Results: Although the population sample was limited, there was an increase in baseline CIMT measurements that occurred in parallel with an increase in baseline homocysteine levels in these patients. At the end of the follow-up period, a bilateral increase in CIMT was observed, which was not correlated to hyperhomocysteinemia. Conclusion: In conclusion, many clinical studies on hyperhomocysteinemia caused by L-dopa therapy in Parkinson patients have been published. However, the relationship between hyperhomocysteinemia and increased risk of vascular disease is still controversial. On the basis of this result, we speculated that hyperhomocysteinemia might lead to an increase in the arterial wall thickness, but its effect on the progression of atherosclerosis is still discussable.

Pleural empyema is defined as the pyogenic infection of the pleural space with purulent effusion. Although it is frequently seen in children and therapy protocols have been developed for it, there are only a few reports about pleural empyema in newborn infants. To our knowledge, just one preterm. infant has been reported in the literature. In this article, we report an male infant born at 29 weeks of gestation who had pleural empyema on the 53(rd) day of life. Multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa) was isolated from his pleural fluid culture. We suggest that this is the first preterm infant with P. aeruginosa empyema.

The purpose of this study was to determine whether renal venous pulsations are affected by compression of the left renal vein (LRV) between the aorta and spine, and also to determine the clinical significance of incidentally detected retroaortic LRV. The study population was recruited from 783 consecutive patients undergoing abdominal CT examination for various indications. 22 patients with a retroaortic LRV were prospectively enrolled in this study, and 22 patients without renal disease served as a control group. After measuring the diameters of the central and peripheral portions of the LRV on CT images, the ratio (P/C) and difference (P-C) of the diameters were calculated. Doppler sonography of the interlobar arteries and veins of the left kidney was then performed to obtain impedance indices. Urine analysis of all subjects and scrotal colour Doppler ultrasound of male patients were also performed. The retroaortic LRV diameters were significantly narrower than the pre-aortic LRV diameters (p=0.002). The left intrarenal venous impedance indices were significantly higher in the patients with retroaortic LRV (p=0.026) and in the subgroups with P/C>2 (p=0.020), with P-C>4 mm (p=0.007) and without nutcracker-like associations (p=0.006) than in control subjects, but no significant difference was noted between the arterial resistance indices. Haematuria (n=8), proteinuria (n=4), varicocele (n=3) and collaterals (n=1) were detected in the study group but not in the control group. In conclusion, incidentally detected retroaortic LRV appears to be associated with haematuria, proteinuria, varicocele and altered venous pulsatility. Further investigations are needed to understand the role of venous Doppler ultrasound in the nutcracker phenomenon. © 2008 The British Institute of Radiology.