Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study.

BACKGROUND: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. METHODS: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. RESULTS: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. CONCLUSIONS: Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

Is inguinal hernia a risk factor for varicocele in the young male population? / ¿Es la hernia inguinal un factor de riesgo para varicocele en el varón joven?

OBJECTIVES: The aim of this study is to investigate the role of the inguinal hernia over the development of varicocele, in cases with accompanying inguinal hernia. METHODS: The continuous variables were calculated from mean and standard deviation, and intermittent variables were calculated over percentage and frequency. Normality testing was performed on continuous variables using the Kolmogorov-Smirnov test. Univariate analyses were performed using the unpaired Mann-Whitney U test and Chi-squared test was used for proportions. Kendall's tau-b correlation coefficient was used for correlition coefficient. Logistic regression modeling were used to identify the impact of inguinal hernias on selected cases. The data were analyzed with SPSS™ for Windows 22 (SPSS,Chicago, IL). RESULTS: Twelve cases (23.1%) in the inguinal hernia group also had varicocele, which was relatively high, whereas 12 cases with inguinal hernia in the varicocele group corresponded to only were 4.02% (12/52 (23.1%) vs 12/298 (4.02%) ). On the other hand, as a result of the binary logistic regression, we found statistically significant difference in the probability of being diagnosed varicocele among the patients with inguinal hernia as 1.94 times. CONCLUSIONS: We think that in addition to the direct compression of some of the inguinal hernias on testicular veins, the potential for a combination of common enzymatic and biochemical disorders in some of the cases involving these two disorders may be play role.

OBJETIVOS: La finalidad de este estudio es investigar el rol de la hernia inguinal respecto al desarrollo de varicocele, en casos con acompañamiento de hernia inguinal.MÉTODOS: Las variables continuas fueron calculadas a partir de media y desviación standard, y las variables discontinuas se calcularon con porcentaje y frecuencia. Se desarrollaron pruebas de normalidad para variables continuas utilizando el test de Kolmogorov-Smirnov. Se realizó análisis univariante usando el test U de Mann-Whitney sin emparejamiento y para proporciones y utilizó el test de Chi cuadrado. Se aplicó el coeficiente de correlación tau-b de Kendall para los coeficientes de correlación. Se usaron modelos de regresión logística para identificar el impacto de la hernia inguinal en casos seleccionados. La información fue analizada con SPSS™ 22 para Windows (SPSS, Chicago, IL). RESULTADOS: Doce casos (23,1%) en el grupo de hernia inguinal tenían también varicocele, incidencia relativamente alta, mientras que solo había 12 casos con hernia inguinal en el grupo de varicocele, que correspondían a un 4,02 % [12/52 (23,1%) vs 12/298 (4,02%)]. Por otro lado, como resultado de la regresión logística binaria, descubrimos una diferencia estadísticamente significativa en la probabilidad de ser diagnosticado varicocele en los pacientes con hernia inguinal (1,94 veces). CONCLUSIONES: Pensamos que además de la compresión directa de algunas de las hernias inguinales de las venas testiculares, el potencial para una combinación de alteraciones comunes enzimáticas y bioquímicas en algunos de los casos, implicando estas dos anomalías, podría desempeñar un papel importante/clave.

Apparent diffusion coefficient value in invasive ductal carcinoma at 3.0 Tesla: is it correlated with prognostic factors?

OBJECTIVE: To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). METHODS: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm(-2)) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. RESULTS: A statistically significant relationship was found regarding axillary lymph node involvement (p = 0.027), and oestrogen/progesterone receptor status (p = 0.013). No significant relationship was detected regarding other prognostic factors (p > 0.05). CONCLUSION: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. ADVANCES IN KNOWLEDGE: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.

Malformations of cortical development: 3T magnetic resonance imaging features.

Malformation of cortical development (MCD) is a term representing an inhomogeneous group of central nervous system abnormalities, referring particularly to embriyological aspect as a consequence of any of the three developmental stages, i.e., cell proliferation, cell migration and cortical organization. These include cotical dysgenesis, microcephaly, polymicrogyria, schizencephaly, lissencephaly, hemimegalencephaly, heterotopia and focal cortical dysplasia. Since magnetic resonance imaging is the modality of choice that best identifies the structural anomalies of the brain cortex, we aimed to provide a mini review of MCD by using 3T magnetic resonance scanner images.

Split-bolus MR urography: synchronous visualization of obstructing vessels and collecting system in children.

Several vascular abnormalities related with urinary system such as crossing accessory renal vessels, retroiliac ureters, retrocaval ureters, posterior nutcracker syndrome, and ovarian vein syndrome may be responsible for urinary collecting system obstruction. Split-bolus magnetic resonance urography (MRU) using contrast material as two separate bolus injections provides superior demonstration of the collecting system and obstructing vascular anomalies simultaneously and enables accurate preoperative radiologic diagnosis. In this pictorial review we aimed to outline the split-bolus MRU technique in children, list the coexisting congenital collecting system and vascular abnormalities, and exhibit the split-bolus MRU appearances of concurrent urinary collecting system and vascular abnormalities.

A randomised clinical trial comparing the patient comfort and efficacy of three different graduated compression stockings in the prevention of postoperative deep vein thrombosis.

AIMS AND OBJECTIVES: To compare the comfort levels of patients regarding the use of three different graduated compression stockings and to analyse the efficacies of the graduated compression stockings in relation to patient comfort and compliance in prevention of postoperative deep vein thrombosis. BACKGROUND: Graduated compression stockings are very important with other prophylaxis methods in postoperative deep vein thrombosis prophylaxis. In meta-analyses and systematic review studies, it was reported that knee-length and thigh-length graduated compression stockings had similar efficacies. However, there is no randomised study in literature regarding the patient problems and levels of comfort with the use of graduated compression stockings of different sizes and pressures. DESIGN: A randomised clinical trial design. METHODS: A total of 219 patients were randomised into three groups (n = 73 in each group). Group I was given low-pressure, knee-length graduated compression stockings, group II was given low-pressure, thigh-length graduated compression stockings and group III was given moderate-pressure, knee-length graduated compression stockings. The level of patients comfort regarding the graduated compression stockings and occurrence of deep vein thrombosis were examined. RESULTS: The vast majority of the patients (79·5%) in group III and 52·1% of the patients in group II stated experiencing problems during the use of the graduated compression stockings (p < 0·001). The graduated compression stockings were reported by the patients as being very comfortable in the group I (p < 0·001). No findings of thrombosis were observed in any of the groups. CONCLUSION: The low-pressure, knee-length graduated compression stockings are as effective as the other graduated compression stockings of different pressures and sizes in the postoperative deep vein thrombosis prophylaxis, and the patients have fewer problems while using these graduated compression stockings with a high satisfaction. RELEVANCE TO CLINICAL PRACTICE: The combined use of pharmacological, mechanical and physical methods and patient education is effective in the prevention of postoperative deep vein thrombosis. The use of low-pressure, knee-length graduated compression stockings in clinical practice may be recommended, as the patients have fewer problems while using these graduated compression stockings with a high satisfaction.

Measures of ventricles and evans' index: from neonate to adolescent.

Ventricle sizes are important for the early diagnosis of hydrocephalus or for follow-up after ventriculostomy. Diameters of ventricles may change, especially in childhood. This study aims to provide normative data about ventricle diameters. Among 14,854 cranial MRI performed between 2011 and 2013, 2,755 images of Turkish children aged 0-18 years were obtained. After exclusions, 517 images were left. Four radiologists were trained by a pediatric radiologist. Twenty images were assessed by all radiologists for a pilot study to see that there was no interobserver variation. There were 10-22 children in each age group. The maximum width of the third ventricle was 5.54 ± 1.29 mm in males in age group 1 and 4.98 ± 1.08 mm in females in age group 2. The Evans' index was <0.3 and consistent with the literature. The third ventricle/basilar artery width ratio was found to be >1 and <2 in all age groups and both gender groups. Our study showed the ventricle size data of children in various age groups from newborn to adolescent. The ventricle volume/cerebral parenchyma ratio seems to decrease with age. We think that these data can be applied in clinical practice, especially for the early diagnosis of hydrocephalus.

Measures of pituitary gland and stalk: from neonate to adolescence.

OBJECTIVE: The aim of this study is to provide normative data about pituitary diameters in a pediatric population. Pituitary imaging is important for the evaluation of the hypothalamo-pituitary axis defect. However, data about normal pituitary gland diameters and stalk are limited, especially in children. Structure and the measurements of pituitary gland and pituitary stalk may change due to infection, inflammation, or neoplasia. METHODS: Among 14,854 cranial/pituitary gland magnetic resonance imaging scans performed from 2011 to 2013, 2755 images of Turkish children aged between 0 and 18 were acquired. After exclusions, 517 images were left. Four radiologists were educated by an experienced pediatric radiologist for the measurement and assessment of the pituitary gland and pituitary stalk. Twenty cases were measured by all radiologists for a pilot study and there was no interobserver variability. RESULTS: There were 10-22 children in each age group. The maximum median height of the pituitary gland was 8.48±1.08 and 6.19±0.88 mm for girls and boys, respectively. Volumes were also correlated with gender similar to height. Minimum median height was 3.91±0.75 mm for girls and 3.81±0.68 mm for boys. The maximum and minimum pituitary stalk basilar artery ratios for girls were 0.73±0.12 and 0.59±0.10 mm. The ratios for boys were 0.70±0.12 and 0.56±0.11 mm. CONCLUSION: Our study demonstrated the pituitary gland and stalk size data of children in various age groups from newborn to adolescent. It is thought that these data can be applied in clinical practice. Future prospective follow-up studies with larger samples, which correlate the structural findings with the clinical and laboratory results are awaited.

Complete disappearance of uptake of FDG in the multifocal liver hemangioendothelioma after radioembolization therapy using yttrium-90 microspheres.

Hemangioendothelioma (HE) is an intermediate grade tumor that originates from vascular endothelium. It is rarely encountered in the liver as multifocal lesions. In the treatment of the hepatic HE, surgical resection, chemotherapy, interferon-alpha 2 therapy and liver transplantation have been described in the literature. Intra-arterial radioembolization therapy with yttrium-90 microsphere is an advanced and promising technique in the treatment of hepatic multifocal HEs. In this report, we aimed to present pre- and post-treatment radio-nuclear imaging features and to discuss radioembolization technique in a 56-year-old patient with multifocal liver HE.