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Objective: The aim of this study is to evaluate the outcome of ablation therapy in our clinic for the treatment of patients with small renal mass Materials and Methods: We retrospectively evaluated the technic and follow-up data of 30 patients with 36 tumors who underwent Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) in our clinic. Demographic data, ablation type, tumor characteristics, peroperative and postoperative complications and treatment success of the patients were evaluated. Results: A total of 36 tumors who underwent ablation treatments, 23 were treated with RFA, 13 with MWA. The mean tumor size was 28.9 ± 6.92 mm in RFA and 29.3 ± 7.70 mm in MWA. 12 (52.1%) of the RFA procedures were applied to the right kidney while 11 (47.8%) were applied to the left kidney. 6 (46.1%) of the MWA procedures were performed on the right kidney and 7 (53.8%) on the left kidney. Of the 36 tumors, 4 (11.1%) were located central and 32 (88.8%) were peripheral. Complications occurred in 2 patients. In one of these patients, acute renal failure and urea creatinine were found to be elevated. In the other patient, local pain was found in the ablation side and minor bleeding was detected at the ablation site in USG. The mean follow-up period was 49.6 ± 24.7 months in patients with RFA and mean follow-up was 16 ± 8,05 months in MWA treatments. The overall success in MWA administration was calculated as 76.9%, while the overall success in RFA was 80%. Conclusion: Long-term oncologic efficacy of RFA appears to be successful in the treatment of T1a renal carcinomas. Further studies can be conducted to elucidate the influence of MWA on long-term oncological outcomes.

The aims of this study were to obtain cephalometric data of orbito-zygomatic skeleton using CT axial images and to determine the presence of sexual dimorphism, normal range of facial asymmetry, and the age-related changes.This study used data from 315 CT scan series of skeletally normal subjects (159 males and 156 females) between the ages of 18 to 90. Two different levels of axial sections were used. In total, 11 measurements were performed and 5 of them were bilateral.The mean values and standard deviations were calculated. Gender and age related changes and asymmetry degree were investigated.Mean values of measurements except left medial orbital wall length, right and left medial orbital wall protrusion, right and left lateral orbital wall angle were significantly larger in males for all age groups. Majority of the measurements was formed by the individuals with larger right side. Similar tendencies were observed for craniofacial asymmetry in both sexes and in different age groups. There were no significant craniofacial asymmetries between age and gender groups in terms of the cephalometric measurements. Mid-interorbital distance had a negative correlation (r = -0.11 and P = 0.043) and interzygomatic buttress distance had a positive correlation (r = 0.15 and P = 0.005) with age.Morphological properties such as sexual dimorphism, symmetry, age related changes are important parameters especially for plastic surgery discipline. The authors hope the data can be helpful in diagnosis and surgical treatment of craniofacial diseases, estimating the prognosis and preparation of the facial prosthesis.

Objective: To determine the quantitative values of apparent diffusion coefficient (ADC), standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), metabolic tumor volume indexes (MTImax, and MTImean) using diffusion weighted-MRI (DW-MRI) and positron emission tomography/computed tomography (PET/CT), and analyze the predictive and prognostic values of these biomarkers in a homogenous group of patients with advanced-stage laryngeal cancer. Methods: Patients with newly diagnosed advanced-stage laryngeal cancer who had both DW-MRI and 18F-FDG PET/CT before treatment, and who had curative cancer treatment (surgery ± adjuvant therapy or radio ± chemotherapy) between 2011 and 2015 were included in this study. All patients were followed up clinically and radiologically, if necessary every 3 months for the first 2 years, every 4-6 months for year 3, and then annually thereafter. Results: Thirty-eight patients were retrospectively analyzed. Our analysis demonstrated statistically significant differences when the pretreatment SUV and MTImean value were compared between patients with stages III and IV. Standardized uptake value was also a predictive factor for N-stage. Moreover, a statistically significant difference was determined when patients with and without perinodal involvement (PNI) were compared. Log rank analysis demonstrated that none of functional imaging-based biomarkers had a prognostic role for oncological outcomes. Conclusion: Our results demonstrated that pretreatment SUV and MTImean values were predictive factors for staging, N-stage and PNI. Indeed, functional imaging-based biomarkers are promising, novel, non-invasive techniques that may provide additional information about tumor characteristics, treatment selection and prognosis in the near future.

Objective: In this study, we aimed to identify the position in which temporal bone anatomical structures and pathologies could be best visualized by applying reconstruction to cross-sections obtained on an axial plane in temporal bone computed tomography (CT) scans. Methods: Sixty patients were examined with temporal bone CT between July 2008 and March 2009. We obtained multiplanar reformatted images by applying retro-reconstruction on various planes from the axial plane sections. Results: We determined that the reconstructed images increased the anatomical and pathological details and significantly contributed to evaluating the relationship between anatomical structures and their pathologies with other normal components. Conclusion: Obtaining multiplanar reformatted images by retro-reconstruction decreased the need for visualization of coronal sections used in standard temporal bone CT exams since the anatomical details were diversified using the new planes. In addition, the dose of radiation received by the patients and the duration of the examination could be reduced by eliminating routine coronal plane sections and obtaining new images using retro-reconstruction.

Congenital intrahepatic portosystemic shunts are rare in children. Portosystemic venous malformations are characterized by extreme clinical variability. We report a full-term 33-day-old male infant presenting with neonatal jaundice. On physical examination, he had generalized icterus and the liver was palpable 3.5 cm below the right costal margin. He had no other symptoms. Laboratory tests showed AST 632 U/L, ALT 198 U/L, total bilirubin 12.1 mg/dL, conjugated bilirubin 10.2 mg/dL, alkaline phosphatase 753 U/L, GGT 47 U/L and glucose 67 U/L. Colour Doppler ultrasonography showed the left portal vein was more dilated than the right portal branch and communication with dilated left hepatic vein. There was no evidence of portal hypertension, heart failure, hepatopulmonary syndrome and encephalopathy during his hospital stay, so he was discharged from the pediatric department and his parents advised to attend monthly follow-up. Congenital portosystemic shunts are rarely observed in the childhood period. 1 Depending on anatomic characteristics they may be intrahepatic or extrahepatic. 2 Intrahepatic portosystemic shunts (PSS) are observed between the portal vein and hepatic vein or vena cava inferior. 3,4 Small shunts may close themselves before the age of 2 years. 5 With the increase in use of imaging methods, diagnosing PSS has become easier, with an increase in the number of cases reported. 6 Neonatal cholestatis is a frequent complication of PSS. 1 We present a case presenting with neonatal cholestasis diagnosed with congenital intrahepatic PSS.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary microangiopathy with adult onset caused by a missense mutation in the NOTCH3 gene in chromosome 19p13. It presents with autosomal dominant arteriopathy, subcortical infarctions, and leukoencephalopathy. Its common clinical presentations are seen as recurrent strokes, migraine or migraine-like headaches, progressive dementia, pseudobulbar paralysis, and psychiatric conditions. Two patients with CADASIL syndrome, whose diagnosis was made based on clinical course, age of onset, imaging findings, and genetic assays in the patients and family members, are presented here because of new familial polymorphisms. The first patient, with cerebellar and psychotic findings, had widespread non-confluent hyperintense lesions as well as moderate cerebellar atrophy in cranial magnetic resonance scanning. The other patient, with headache, dizziness, and forgetfulness, had gliotic lesions in both cerebral hemispheres. CADASIL gene studies revealed a new polymorphism in exon 33 in the first patient. In the other patient, the NOTCH3 gene was identified as a new variant of p.H243P (c.728A > C heterozygous). By reporting a family presenting with various clinical symptoms in the presence of new polymorphisms, we emphasize that CADASIL syndrome may present with various clinical courses and should be considered in differential diagnoses. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.

Abdominoplasty and augmentation mastopexy are often performed in the same operation. Although silicone breast implants are usually used for breast augmentation, resected abdominal dermis fat tissue can be used for this purpose. We describe a new autologous breast augmentation technique using dermis fat grafts obtained from a simultaneous abdominoplasty operation.This new technique was used in eight breasts of four patients who requested abdominoplasty and augmentation mastopexy operations in the same session. First, excess abdominal skin was de-epithelized. Dermis fat strips were harvested either in situ or extracorporeally from this area. The prepared strips were then inserted into the pectoralis major muscle during the mastopexy operation.The patients were followed up for 7 months to 6 years. No infection or other problems regarding the technique were observed. Magnetic resonance imaging obtained from one patient showed graft survival after 2 years. A slight augmentation, presumably 50 to 100 mL, was observed per breast in all of the patients.Dermis fat strips obtained from an abdominoplasty operation can be used to obtain slight augmentation during mastopexy in patients requesting both of these operations in the same session. Validation of this new technique requires more experience with additional patients.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Objectives: To investigate the diagnostic efficiency of elastography in differentiation of malignant and benign tumors by evaluating salivary gland masses in means of their elastography scores and strain ratios. Patients and Methods: Twenty five patients with salivary gland mass lesions were detected through B- mode ultrasonography, Doppler ultrasonography, strain elastography and their strain ratios were calculated. The results were compared with histopathologic results. Results: Twenty five patients had 27 lesions consisting of seven malignant and 20 benign lesions. Mann Whitney U test, ROC analysis, Fisher test and Chi square tests were used statistically. Mean strain rates were calculated as 2.26 ± 0.29 in the benign group and 2.02 ± 0.59 in the malignant group. There was no statistically significant difference between the two groups (P = 0.698). Elastography score was calculated as mean 2.4 ± 0.94 in the benign group and mean 2.28 ± 0.38 in the malignant group. There was no statistically significant difference between the two groups (P = 0.708). Accepting the strain rate as 0.89; sensitivity of elastography in differentiating malignant from benign lesions is 71%, and the specificity is 50%. However, the area under the ROC curve is 0.55, which is not statistically significant (P = 0.699). Conclusion: In conclusion, elastography is a supporting method for B-mode ultrasonography in the differentiation of benign and malignant salivary gland masses. However, the overlap of elastographic findings is evident in benign and malignant masses. Care should be taken to have tissues with similar stiffness under the reference tissue and the lesions in elastographic evaluation of the superficial mass. We have not met a study that has pointed out the importance of stiffness of the tissue located beneath the lesion that may affect the elastography results in the literature. In this respect our study is unique. © 2017, Iranian Journal of Radiology.

Coronary artery aneurysms (CAAs) represent a rare pathology. However, the true burden of CAAs may be currently underestimated. The use of newer imaging technologies, such as computed tomography and magnetic resonance coronary angiography, may assist in unraveling its true prevalence (1). Atherosclerosis is the main etiology of CAAs. It has been reported that 50% of CAAs are due to atherosclerosis (2). Congenital, inflammatory, and connective tissue disorders are the other possible etiological factors that promote CAA development (3-4). Recently, genetic factors have been proposed as an alternative etiology (5). Polyarteritis nodosa (PAN) is an arteritis affecting small- and medium-sized arteries. Renal and gastrointestinal involvement is more frequent. Because reports on coronary involvement in the context of PAN are rare, the natural course of PAN-related CAAs and optimal treatment strategies remain poorly defined.

Climatic and altitude features of living region may affect human body. Many changes in several tissues and organs and several health problems due to climatic and altitude effects were defined in the literature. However, there were limited number of studies which evaluated correlation between development of frontal sinus and climatic/altitude effect. In this study, widths, heights, AP lengths and volumes of frontal sinus were compared by Paranasal CT scans in populations living in Van which has colder climate and higher altitude and Manisa which has milder climate and lower altitude. It was found that widths, antero-posterior lengths and volumes of frontal sinus were higher in populations living in colder climate and higher altitude according to populations living in milder climate and lower altitude. Heights of frontal sinuses were on the contrary of this. These results were found appropriate to increasing of cephalic index in cold climate according to Allen's Rule. We suggest that larger population study should be made with peoples having the same or similar race and genetic structure in different climate and altitude regions and the proportional comparison of frontal sinus measurements with cephalic index should be considered in future studies.

Choledochal cysts are relatively rare congenital anomalies which are characterized by dilatation of the extra-and/or intra-hepatic bile ducts. Pancreatic involvement before choledochal cyst operation might be a risk factor for postoperative pancreatitis. In this case report, we present a patient who had pancreatic enzyme elevation before choledochal cyst operation and who developed acute pancreatitis after surgery.

On magnetic resonance imaging (MRI), T1 hyperintense vertebral bone lesions are almost benign. However, metastatic bone malignant melanoma can show high signal on T1 sequences due to melanin and hemmorhagic component. In this present case, we report T1 hyperintense lumbar bone metastasis in a metastatic melanoma patient. T1 hyperintense metastasis is a very rare condition with a few case reports in the literature so far.

Evaluation of neck masses is frequent in ear, nose, and throat clinics. Successful outcomes associated with neck mass are directly related to rapid diagnosis and accurate treatment for each patient. Late diagnosis of a malignant mass increases the magnitude of morbidity and the rate of mortality of the disease. Although magnetic resonance imaging and computed tomography (CT) examinations are important tools for evaluating head and neck pathologies, they do not allow functional evaluation. For this reason, CT perfusion (CTP) as a method of functional evaluation for distinguishing benign from malignant masses is gaining attention. The utility of CTP for distinguishing between benign and malignant mass lesions was investigated in 35 patients with masses in the neck (11 benign, 24 malignant). CTP was shown to be a useful method for identifying head and neck tumors and blood volume values to enable the differential diagnosis of benign and malignant head and neck tumors.

We report a case of a 32-year-old female patient who presented with decreased vision on both eyes and headache. In fundus examination, both eyes had elevation of the optic disc and star shaped hard exudates in the macula. Magnetic resonance imaging was completely normal except the saccular dilatation of bilateral optic nerve sheath. The patient was treated with oral steroids following high-dose intravenous methylprednisolone. She displayed good anatomical and functional results during the follow-up. This case raises the possibility that optic nerve sheath enlargement, probably induced by an idiopathic inflammatory optic neuritis, may simulate dural ectasia of the optic nerve sheath.

Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the fetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important due to the recently described management options. We report here two cases of CHAOS due to tracheal atresia diagnosed by antenatal ultrasonography and fetal MRI. We also briefly review the relevant literature with the associated management options.

AIM Behcet's disease (BD) is a multisystem disorder that is characterized by vasculitis, and consists of a triad of recurrent ulcers of the oral and genital mucosa with relapsing uveitis. The prevalence of pulmonary involvement varies in the range of 1-10% in various studies, and its complications are severe and life threatening. To objectively assess the degree of pulmonary vascular endothelial damage in BD, the lung uptake, and the clearance rate of technetium-99m-hexamethylpropylene amine oxime (Tc-99m-HMPAO) were determined. METHODS Twenty-three nonsmoking patients with BD (10 female, 13 male) and 11 (six female, five male) healthy nonsmoking controls underwent Tc-99m-HMPAO lung scanning, pulmonary function tests (PFT), chest radiograph examination, contrast-enhanced spiral chest computed tomography scanning, and high-resolution computed tomography examinations. Immediately after the bolus injection of 740 MBq of Tc-99m-HMPAO posterior sequential images were obtained at 1-s intervals for 150 s and subsequent images were obtained at one frame per minute (min) over a 10-min period, using a double-headed gamma camera equipped with a low-energy all-purpose parallel hole collimator. Dynamic images were used to calculate the Tc-99m-HMPAO lung clearance rate (T1/2). Simultaneously, a static anterior image, including a large part of the liver, was obtained of 5-min duration at 10 min after the injection. Regular regions of interests were drawn over the midportion of the right lung and the highest activity area of the liver parenchyma was selected and lung/liver (L/Li) uptake ratios were calculated to represent the degree of pulmonary vascular endothelial damage. RESULTS Chest radiograph, high-resolution computed tomography, and computed tomography findings in patients with BD were nonspecific for BD. There was also a statistically significant difference between patients with BD (30.26 ± 10.55 s) and normal controls (19.53 ± 6.24 s) on their T1/2 values (P = 0.0004). The results show that the L/Li ratios on the Tc-99m-HMPAO lung scan were significantly higher in patients with BD (0.60 ± 0.19) than those in normal controls (0.39 ± 0.07) (P = 0.0021). Using a cutoff value of 0.50, 15 of 23 (65%) patients with BD had increased L/Li ratios. No correlation was found between the mean T1/2 values of Tc-99m-HMPAO clearance and the PFT in patients with BD. The L/Li ratios were not correlated with PFT in patients with BD. CONCLUSION The degree of pulmonary vascular endothelial damage was represented as increased L/Li ratios and decreased lung clearance rate measured on the Tc-99m-HMPAO lung scan in patients with BD. Our results indicated that determining the T1/2 values and the L/Li ratios on Tc-99m-HMPAO lung imaging should be an objective method to assess subclinical pulmonary damage even in the early stages of BD in the patients.

Alkan F, Düzgün F, Yüksel H, Tarhan S, Coşkun Ş. Percutaneous embolization of congenital portosystemic venous shunt in an infant with respiratory distress. Turk J Pediatr 2018; 60: 456-459. A 5-month-old boy with progressive respiratory distress was admitted to our hospital. Physical examination revealed mild tachypnea and retraction. The left main bronchus was found as severely collapsed between the right pulmonary artery and the descending aorta, on the bronchoscopic evaluation. Further evaluation revealed persistent ductus venosus (PDV). As in the fetal period the ductus venosus arises from the posterior aspect of the left portal vein, a PDV is considered another type of intrahepatic portosystemic shunt. Therefore, he was diagnosed with congenital portosystemic venous shunt, leading to persistent respiratory distress. The PDV was closed with Amplatzer vascular plug II, and then he had immediate clinical improvement. Congenital portosystemic venous shunts (CPSS) are rare vascular malformations associated with severe complications. Here we presented a case with progressive respiratory distress as a result of CPSS and rapid improvement after embolization.

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.Res...

We assessed the anatomical variations of the globe and optic nerve in tilted disk (TD) syndrome using magnetic resonance imaging (MRI) findings and compared them with a control group. Eleven patients diagnosed with TD syndrome during eye examination were referred for MRI of the sella and chiasm to exclude intracranial mass lesions. The shape of the globe, the chiasmal angle, the insertion angles of the optic nerve in axial and parasagittal planes determined by lines parallel to the optic nerve and tangent to the globe in TD syndrome were compared with a control group consisting of 53 cases. Gender ratios were 7/4 (F/M) for the TD group and 35/18 for the control group (p>0.05). The insertion angle of the optic disk to the globe was wider in the temporal quadrant (p The relationships of the optic disk and the globe were significantly different in patients with TD syndrome in comparison to the control group. TD syndrome is related to the malalignment of optic nerve and globe in the horizontal plane.

Crohn’s disease is an inflammatory disorder and may affect any part of gastrointestinal tract. The signs and symptoms of Crohn’s disease are similar to many other abdominal disorders. Crohn’s disease does not typically present as an acute abdomen. However, Crohn’s disease should be considered in the differential diagnosis of patients with abdominal pain, especially relevant to patients with a long history of vague abdominal complaints and those with unexplained weight loss or growth retardation. In this case report, we present such a patient of acute abdomen admitted to us after appendectomy and diagnosed Crohn’s disease finally.

Amaç: Normal sperm parametrelerine sahip sol varikolselli hastalar ile sa ğlıklı kontrol grubu aras ındaki testiküler kan akımı de ğerlerini karşıla ştırmaktır. Gereç ve Yöntem: Çalışmaya sol varikoselli 40 hasta ve 25 sa ğlıklı gönüllü dahil edildi. Tüm katılımc ıların her iki testislerindeki kan ak ımı renkli Doppler ultrason ile değ erlendirildi. Testiküler kan akımları testiküler, kapsüler ve intratestiküler arterlerde ölçldü. Hasta grubunda ayrıca semen parametreleri de de ğerlendirildi. Her iki gruptaki testiküler kan akım de ğ erleri istatistiksel olarak karşıla ştırıldı. Bulgular: Hasta ve kontrol grubunun ortalama ya şları sıras ı ile 24,92±4,34 ve 23,42±4,42 idi (p>0,05). Sol testiste sadece testiküler arterin rezistans indeksi hasta grubunda anlamlı olarak düşük bulundu (p=0,02). Sağ tetstiste ise testiküler arterin hem rezistans hem de pulsatil indeksleri hasta grubunda anlamlı olarak düşüktü (sırası ile p=0,01; p=0,01). Sonuç: Her iki testisteki kan ak ım parametrelerinin ço ğunlu ğunda fark ç ıkmamas ı hastaların normal semen parametrelerine sahip hastalar olmasından kaynaklanabilir. Anormal sperm parametrelerine sahip varikoselli hastalarda testiküler kan ak ımının de ğ erlendirildiği uzun takip süreli ileri çalış malar yapılmasını önermekteyiz . Objective: To compare the changes of testicular blood supply in the control group and patient group with varicocele and normal sperm parameters. Material and Method: 40 patients with left varicocele and 25 healthy controls were enrolled in the study. All participants were performed color Doppler sonography to assess testicular blood flow of the both right and left testes. Blood flow parameters were measured in testicular, capsular and intratesticular arteries. Semen parameters were also assessed in the participants of the patient group. Testicular blood flow parameters were compared between the two groups. Results: Mean ages of the patients and controls were respectively, 24,92±4,34 and 23,42±4,42(p>0,05). In the left testes; only the resistive index values of testicular artery were significantly lower in the patients (p=0,02). In the right testes; the resistive and pulsatility index values of testicular artery were significantly lower in the patients (p=0,01; p=0,01). Conclusion: Most of testicular blood flow parameters in the both testes were similar. These may be the result of the normal semen parameters of the patients. We suggest that testicular blood flow in patients with varicocele and normal sperm parameters should be investigated by further studies with long term follow up.

The aim of the study was to ascertain whether spiking of the tibial tubercle is associated with cartilage defects detected by magnetic resonance imaging (MRI) in patients with osteoarthritis (OA) of the knee joint. Angulation of the tip of the medial and lateral tubercles, and the height of the tubercles above the tibial plateau were measured on a standard anteroposterior radiograph of the knee joint. Cartilage defects in the tibiofemoral joint (TFJ) were determined by MRI examination. The lengthening and sharpening of the angles of the tubercles were significantly more prominent in the patients than controls. A strong association was found between angulation (if less than 70 degrees) and especially the height (if more than 0.16) of the medial tibial spike and MRI-detected cartilage defects in the medial tibiofemoral compartment. The predictive value of the spiking of tibial tubercles for MRI-detected cartilage defects in TFJ is related to the degree and size of the spiking. The presence of tibial spiking itself may not be a reliable sign of early OA.

A 52-year-old male patient had a right humorous fracture 6 weeks before seeking surgical treatment. On transthoracic echocardiography, the pulmonary artery aneurysm was measured, at its widest point, to be approximately 9.07 cm in diameter with a thrombus inside the main pulmonary artery. Thoracic computerized tomography confirmed the presence of an aneurysm in the main pulmonary artery of approximately 9.05 cm diameter with a thrombus involving the right main pulmonary artery.

The aim of this study was to determine the endothelial function in patients with primary Sjogren's syndrome (SS). We also aimed to determine whether endothelial (dys)function correlates with extraglandular manifestations, specific autoantibodies and the severity of salivary gland involvement of SS. Endothelium-dependent vasodilation and endothelium-independent vasodilation of the brachial artery were assessed by a high-resolution ultrasound on 25 patients with primary SS and on 29 healthy controls. Patients with primary SS had significantly less mean endothelium-dependent vasodilation than did controls (3.0 +/- 0.4% vs 4.2 +/- 0.3%; p = 0.012). Endothelium-independent vasodilation induced by sublingual glycerol trinitrate was not different between the two groups (12.9 +/- 1.4% vs 14.1 +/- 1.2%; p = 0.86). We concluded that endothelium-dependent vasodilation was impaired in primary SS patients, in particular those presenting with Raynaud's phenomenon, when compared with the healthy controls and this impairment was not associated with the presence of RF, ANA, anti-Ro/SS-A, anti-La/SS-B and with the other extraglandular manifestations of the disease.

Objectives To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth. Methods The study involved 43 healthy term neonates who were delivered vaginally (n = 20) or by Cesarean section (n = 23). All fetuses/neonates were examined by Doppler ultrasound to obtain middle cerebral artery (MCA) and cerebral transverse sinus (Tsin) Doppler waveforms on three occasions (before delivery, and 1 h and 24 h after birth). Pulsatility index (PI) and peak systolic velocity (PSV) for MCA and Tsin were measured and compared between neonates who were delivered vaginally or by Cesarean section. Umbilical cord blood samples were analyzed for umbilical artery and vein pH, pO2 and pCO2 and values were correlated with MCA and Tsin Doppler indices. Results MCA-PI increased and MCA-PSV decreased at 1 h after birth, and Doppler measurements returned to predelivery values at 24 h after birth. Tsin Doppler measurements remained unchanged at 1 h and 24 h when compared to predelivery values in both the Cesarean and vaginal delivery groups. There was a negative correlation between Tsin-PI before birth and umbilical venous pH. There was a positive correlation between Tsin-PSV at 1 h after birth and umbilical vein pCO2. Conclusions Cerebral arterial blood velocity decreases immediately after birth and increases within 24 h, probably as part of neonatal adaptation. Cerebral venous blood velocity remains constant during the perinatal period and is likely to be regulated in a different and more complex manner than that of arterial blood velocity. Mode of delivery does not affect cerebral blood velocity. Copyright  2004 ISUOG. Published by John Wiley & Sons, Ltd.

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.

This study was designed to evaluate the effects of propofol alone and propofol-clonidine combination on human middle cerebral artery blood flow velocity (Vmca) and cerebrovascular carbon dioxide (CO2) response by using transcranial Doppler ultrasonography. Mean Vmca in response to changes in arterial partial pressure of CO2 (Paco2) was determined under the following conditions: awake (group 1), propofol anesthesia (group 2), and combined propofol-clonidine anesthesia (group 3). Normocapnic, hypercapnic, and hypocapnic values of heart rate, mean arterial pressure, partial end-tidal CO2 pressure, Paco2, and Vmca were obtained. The mean Vmca in groups 2 and 3 was significantly lower than that in group 1 at each level of Paco2. The calculated Vmca at each level of Paco2 was not different between groups 2 and 3. There was a correlation between Paco2 and Vmca in all groups, but in the anesthetized groups the effect of Paco2 on Vmca was attenuated. The present data demonstrated that clonidine-propofol does not change CO2 reactivity compared with propofol alone, but both anesthetics attenuate cerebral blood flow compared with awake controls.

This is a case report of Chiari type 2 (C2) malformation associated with a thyroglossal duct cyst. A 3-month-old female patient with myelomeningocele was examined with cranial and spinal MRI. The imaging protocol included T1- and T2-weighted sequences. MRI revealed typical findings of C2 malformation and a thyroglossal cyst located at the base of the tongue. We hypothesize that occurrence of C2 malformation and the thyroglossal cyst is not totally independent, but instead, their association shown in the present case may be related to incomplete embryonic development. However, further studies and research are needed in order to prove this hypothesis.

To investigate the relationship between postoperative MRI findings and the severity score of incontinence in patients treated with pubovaginal sling surgery. Materials and methods: Fifty-two female patients treated with pubovaginal slings were included in the study. These patients' severity scores of incontinence were evaluated in the postoperative 6th month. All the patients were examined using MRI on the same day. A T2-weighted sagittal image of the midline structures, including the symphysis, urethra, and coccyx, was obtained at rest and at maximal strain. The mobility of the bladder floor and change in the posterior urethrovesical angle were calculated for each patient. Relationships between the severity score of incontinence and mobility of the bladder floor and change in the posterior urethrovesical angle were analyzed using Spearman's rank correlation coefficients by means of SPSS. Results: A positive correlation was found between the severity score of incontinence and the mobility of the bladder neck and also between the score and the degree of posterior urethrovesical angle (r = 0.797, P = 0.000; r = 0.62, P = 0.000, respectively). There was also a positive correlation between the severity score of incontinence and the increase in posterior urethrovesical angle during Valsalva's maneuver (r = 0.47, P = 0.02). Conclusion: MRI is a non-invasive diagnostic method for the evaluation of bladder floor position, mobility of the bladder neck, and posterior urethrovesical angle in patients with stress urinary incontinence. It can play a major role in the postoperative follow up of stress urinary incontinence. MRI can also be used for the assessment of success in pubovaginal sling surgery.

Sinonasal-type hemangiopericytomas, which comprise less than 0.5% of all sinonasal neoplasms, arise unilaterally in the nasal cavity as polypoid masses with a mean diameter of about 3 cm. A 34-year-old female patient was admitted due to nasal obstruction and epistaxis. A polypoid mass covered with intact mucosa that originated both from the right inferior concha and lateral nasal wall was detected by nasal endoscopy. The tumor, extending from the oropharynx to the nasopharynx, was measured as 3,5x3x2 cm. Although exhibiting characteristic histopathological features and typical clinical symptoms, this case with unexpected immunohistochemical findings can provide a viewpoint on the nature of this kind of tumors.

Susac syndrome is a rare disease of unknown pathogenesis. It is caused by a microangiopathy affecting the arterioles of the brain, retina, and cochlea, giving the classic clinical triad of subacute encephalopathy, visual loss secondary to retinal branch occlusions, and sensorineural hearing loss. Magnetic resonanace imaging, retinal fluorescein angiography, and audiography findings enable diagnosis. Early therapy may reduce sequelae and improve recovery. Herein we report a case of Susac syndrome with all the findings of the disease.Keywords: Magnetic resonance imaging, microangiopathy, Susac syndrome ÖzetSusac sendromu patogenezi bilinmeyen nadir bir hastalıktır. Beyin, retina ve kohleanın etkilendiği mikroanjiyopati sonucunda ortaya çıkar. Bu durum hastalığın tipik triadı olan subakut ensefalopati, retinal arteriollerin tıkanmasına bağlı oluşan görme kaybı ve sensorinöral işitme kaybına neden olur. Manyetik rezonans görüntüleme, retinal floresan anjiografi ve odyografi bulguları tanıya yardımcıdır. Erken tedavi sekel oluşumunu azaltabilir ve iyileşemeyi hızlandırabilir. Bu yazıda hastalığın tüm bulguları ile birlikte bir Susac sendromlu olguyu sunuyoruz.Anahtar sözcükler: Manyetik rezonans görüntüleme, mikroanjiyopati, Susac sendromu, Susac sendromu patogenezi bilinmeyen nadir bir hastalıktır. Beyin, retina ve kohleanın etkilendiği mikroanjiyopati sonucunda ortaya çıkar. Bu durum hastalığın tipik triadı olan subakut ensefalopati, retinal arteriollerin tıkanmasına bağlı oluşan görme kaybı ve sensorinöral işitme kaybına neden olur. Manyetik rezonans görüntüleme, retinal floresan anjiografi ve odyografi bulguları tanıya yardımcıdır. Erken tedavi sekel oluşumunu azaltabilir ve iyileşemeyi hızlandırabilir. Bu yazıda hastalığın tüm bulguları ile birlikte bir Susac sendromlu olguyu sunuyoruz.

Amaç: Varikosel hastalarında görülen sperm parametre bozukluğu hakkında çok sayıda teori ileri sürülmüştür. Bu teorilerden biri de, testisin arteriyel kan akımındaki deği- şikliklerdir. Biz çalışmamızda; sol varikoseli ve normal sağ testisi olan hastaların sağ ve sol testislerindeki arteriyel kan akım değerlerini karşılaştırmayı amaçladık. Yöntemler: Üroloji polikliniğine başvuran ve fizik muayenesinde sol varikosel saptanan 41 erkek çalışmaya alındı. Sağ ve sol testislerindeki kan akımını değerlendirmek için tüm hastalara renkli doopler ultrason yapıldı.Her iki testisteki testiküler, kapsüler ve intratestiküler arterlerdeki pik sistolik hız, end diyastolik hız, resisitive ve pulsatilite indeksleri ölçüldü. Semen parametreleri de ayrıca değerlendirildi. Her iki testisin kan akım değerleri karşılaştırıldı. Bulgular: Çalışmaya katılan hastaların yaş ortalaması 25,95±5,27(16-37) idi. Tüm hastaların sperm parametre ortalamaları; ml deki sayı(milyon) 31,56±19,05, hareket(%) 51,21±22,27, morfoloji(%) 12,75±2,97 ve total motil sperm sayısı 54,92±47,46 olarak belirlendi. Testiküler arter ile bu arterin testis içindeki dalları olan kapsüler ve parankimal arterlerin pik sistolik hızları, diastol sonu hızları, direnç ve pulsatilite indeksleri arasında her iki testis karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı(p>0,05). Sonuç: Sağ ve sol testiküler akım değerlerinde anlamlı bir farklılık saptanmaması, çalışmanın sperm parametreleri normal sınırlarda olan bir grupla yapılmasına bağlanabilir. Sperm parametreleri etkilenmiş başka bir sol varikoselli hasta grubuyla karşılaştırmalı olarak yapılacak yeni çalışmalara gereksinim duyulmaktadır. Objective: There are many theories about the mechanism how varicocele causes infertility. One of these theories is about the negative effect of varicocele on testicular blood flow. We aimed to compare the measurements of testicular blood flow in right and left testes in patients with left varicocele and normal right testes. Methods: Forty-one patients with left varicocele were enrolled in the study. All participants were performed color Doppler sonography to assess testicular blood flow of the both testes. Blood flow parameters such as peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), pulsatility index (PI) were measured in testicular, capsular and intratesticular arteries. Semen parameters were also assessed in the participants. Testicular blood flow parameters were compared between the two testes. Results: Mean age of the patients was 25,95±5,27(16- 37). The mean semen parameters of the patients; sperm count (million/ml) was 31.56±19.05, motility (%) was 51.21±22.27, normal morphology (%) was 12.75±2.97 and total motile sperm count (million/ml) was 54.92±47.46. There were no statistically significant differences between the testicular blood flow parameters of both testes which are PSV, EDV, RI and PI values in the testicular artery and its branches (capsular and intratesticular arteries) (p>0.05). Conclusion: The fact that there were no differences between the blood flows in both testes may depend on the study group who had normal sperm parameters. We suggest that testicular blood flow may be evaluated in patients with left varicocele and impaired sperm parameters.

Background: To evaluate the results of various types of radiofrequency ablation (RFA) treatment of renal tumors in patients with excessive anesthetic and surgical risk. Materials and Methods: Data for RFA performed in in high risk patients were retrospectively evaluated. Other RFA applications in patients with no anesthetic and/or surgical risk were excluded. RFA was by ultrasound or CT guided percutaneous (USG/CT-PRFA) and retroperitoneally or transperitoneally laparoscopic (R/T-LRFA) techniques under general or local anethesia. Follow-up data of enhanced CT or MRI after 1, 3 and 6 months were analysed for twelve RFA applications. Results: The RFA applications included 4 (40%) left-sided, 5 (50%) right-sided and 1 (10%) bilaterally RFA (simultaneously 1 right and 2 left). The localizations of tumors were 2 (16.6%) upper, 5 (41.6%) mid and 5 (41.6%) lower pole. The RFA applications included 9 (75%) USG-PRFA, 1 (8.3%) CT-PRFA, 1 (8.3%) T-LRFA and 1 (8.3%) R-LRFA. The mean age was 65.3±8.5 (52-76) years. The mean tumor size was 29.6±6.08 (15-40) mm. No complications related to the RFA were encountered in any of the cases. Failure (residual tumour) was determined in 8.3% (1/12) of USG-RFA application. The success rate was thus 91.7% (11/12). Other 1 st , 3 rd and 6 th months follow-up data revealed no residua and recurrence. Conclusions: RFA application appears to be safe as a less invasive and effective treatment modality in selected cases of small renal tumors in individuals with excessive anesthetic and also surgical risk.

Objective: Efficacy of collar treatment on clinical symptoms and vertebral blood flow was examined in 23 patients with cervical spondylartrosis complaining of vertigo. Methods: In pretreatment and posttreatment periods, the following parameters were studied: 1) frequency of cervicocephalic symptoms, 2) influence of severity of the vertigo on daily life activity, 3) range of active cervical joint movement, 4) pain in cervical palpation, 5) vertebral blood flow by Doppler ultrasonography, and audiologic and brainstem auditory evoked potential (BAEP) examinations for hearing. Results: Following 1 month of collar treatment, vertigo and amnesia were the only symptoms which were significantly relieved (p=0.01, p=0.03). In addition, the severity of the symptoms were noticeably decreased. Range of cervical joint movements on extention, lateral flexion and rotation were increased. Cervical palpation was reduced and the pain was less. However, no change was observed in vertebral blood flow, audiometric and BAEP examinations. Conclusion: It was concluded that vertigo in cervical spondylartrosis was not a consequence of vertebrobasillar insufficiency. Hypertonicity in cervical muscles was the primary reason for vertigo in these patients.

Bilgisayarlı tomografik (BT) tersine dönme işareti difüz anoksik-iskemik beyin hasarı ile birlikte olup hemen daima çocuklarda görülür. Literatürde sadece menenjitli yetişkin bir hastada bildirilmiştir. Metil alkol intoksikasyonu genellikle iki taraflı putaminal nekroz ile birliktedir. Metil alkol intoksikasyonunda BT tersine dönme işareti daha önce literatürde tanımlanmamıştır. Bu yazıda metal alkol intoksikasyonlu yetişkin bir hasta ve BT tersine dönme işareti sunulmaktadır., The computed tomographic (CT) reversal sign is associated with diffuse, anoxic/ischemic cerebral injury, and is seen almost exclusively in children, and only one adult patient with meningitis exists in the literature with this sign. On the other hand, methyl alcohol intoxication is usually associated with bilateral putaminal necrosis, and no CT reversal sign has been observed before in this condition. This report presents an adult patient with methyl alcohol intoxication, and the CT reversal sign.

We aimed to investigate the long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow using color Doppler sonography (CDS) in this observational study. A total of 30 patients clinically diagnosed with left varicocele who underwent a microsurgical inguinal varicocelectomy were examined 3 times with CDS for testicular blood flow parameters, first before, then 3 months after, and finally 6 months after the operation. CDS values of testicular blood flow (peak systolic velocity, end diastolic velocity, resistive index, and pulsatility index) were measured from testicular, capsular, and intratesticular arteries. We also evaluated preoperative and postoperative semen parameters. The mean values of blood flow velocities in the left testicular artery (peak systolic and end diastolic) increased and resistance indices (resistive and pulsatility) in the left capsular and intratesticular arteries decreased significantly after surgery (P < .05). No significant difference was detected between the preoperative and postoperative blood flow parameters in the right testicular, capsular, or intratesticular arteries (P < .05). In the semen analysis run 3 months after the operations, statistically significant increases were found in sperm concentration (P < .001), morphology percentage (P < .001), and total motile sperm concentration (P = .009). The increase in blood flow velocity in the testicular artery and the decrease in resistive and pulsatility indices in the capsular and intratesticular branches of the artery may be strong indicators of an increase in testicular arterial blood flow into the testicular tissue. Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after microsurgical inguinal varicocelectomy.

Most intracranial dissecting aneurysms involve the posterior circulation, and the intradural segment of the vertebral artery is affected in majority of these. The aim of this report is to summarize the results of endovascular treatment in patients with ruptured dissecting aneurysms of the non-vertebral posterior circulation.During the past six years, the medical records of 23 patients with subarachnoid hemorrhage related to dissecting aneurysm arising from non-vertebral arteries of the posterior circulation were reviewed retrospectively.The locations of the aneurysms were as follows: seven in the posterior cerebral artery, five in the superior cerebellar artery, six in the basilar artery trunk, and five in the posterior inferior cerebellar artery. Two basilar artery aneurysms were treated in the chronic stage with stent-assisted coil embolization. In the remaining patients, the aneurysm was coiled with or without parent vessel occlusion in the acute stage. One patient re-bled and died 20 days after initial treatment. At follow-up, recanalization had occurred in two patients, whose aneurysms were re-embolized successfully. Overall, three patients had permanent neurological sequelae, two had transient neurological sequelae, and one patient died.Embolization with or without parent artery occlusion is feasible with an acceptable morbidity and mortality rate in the treatment of dissecting aneurysms confined to non-vertebral arteries of the posterior circulation.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is rare in patients under the age of 40 in the absence of metabolic or familial predisposition. A high incidence of involvement of the transverse ligament of the atlas in CPPD deposition disease was reported. However, involvement of the craniocervical junction is rarely symptomatic. We report a rare case in a young male with severe idiopathic CPPD crystal deposition disease, including crowned dens syndrome in the cervical spine.

Amaç: Lateral epikondilit (LE) esasen klinik olarak tanınır. Ultrasonografi (US) LE'nin şiddeti, boyutu ve yerleşimi hakkında yararlı bilgi sağlayabilir. Amaç, LE'nin doğrulanması için US'nin kullanılması ve bu hastalarda ağrı, kavrama gücü, fizik bakı ve engellilik arasındaki ilişkileri incelemekti.Yöntem ve Gereçler: Unilateral LE'li 52 hasta US ile incelendi. Ağrı ve fonksiyonel durum görsel analog ölçütü, Yaşam Kalitesi Short Form-36 (SF-36), patient-rated forearm evaluation questionnaire (PRFEQ) kullanılarak belirlendi. Kavrama gücü ve LE için manüel testler değerlendirildi.Bulgular: Hastaların 28'inde (%53.8) LE'nin klinik tanısı US ile doğrulandı. Sonuçlarımız sonografisi anormal hastalarda, klinik muayene bulgularıyla SF-36 ve PRFEQ ağrı değerlendirmeleri arasında yakın ilişkiyi gösterdi. Bu hastalarda kavrama gücüyle de klinik ve fonksiyonel değerlendirmeler arasında karşılıklı ilişki vardı.Sonuç: LE'de engellilik değerlendirmesinde geleneksel klinik muayeneden başka yöntemlere ihtiyaç olduğu kanısına vardık. LE'nin sonografik bulguları olan hastalarda, ağrı ve kavrama gücü ölçümleri şiddet ve engelliğin değerlendirilmesinde sayısal ve nicel bilgi verir. Objective: Lateral epicondylitis (LE) is generally diagnosed clinically. Ultrasonography (US) can provide useful information about the location, extent, and severity of LE. Our objective was to use US to confirm LE and to investigate the relationships between pain, grip strength, physical examination, and disability in these patients.Material and Methods: Fifty-two patients with unilateral LE were examined by US. Pain and functional status were assessed using a visual analog scale (VAS), physical functioning and bodily pain scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and a patient-rated forearm evaluation questionnaire (PRFEQ). Grip strength and manual tests for LE were evaluated.Results: Clinical diagnosis of LE was confirmed by US in 28 (53.8%) patients. Our results showed close associations between clinical examination findings and SF-36 and PRFEQ assessments with pain in patients who had sonographic abnormalities. Grip strength was also correlated with clinical and functional evaluations in these cases. Conclusion: We concluded that evaluation of disability in LE requires methods different from those included in the traditional clinical examination. Pain and grip strength measurements provide numerical and quantitative data for evaluation of severity and disability in patients with sonographic findings of LE.

The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 +/- 13.34 (range 20-83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31-40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity.