Rare metastasis in a patient with BRAF-mutated rectal cancer: choroidal metastasis - case report and literature review.

Purpose: Colorectal cancers are common and have high mortality, and metastasis is common in follow up. Choroidal metastasis is encountered rarely in rectum cancers, and there is no previous case reported from Turkey. We present our patient who developed choroidal metastasis in his cancer follow-up. Case report: A 74-year-old male patient had undergone operation due to the diagnosis of rectum cancer two years ago, and lung (L) metastasis developed in the 4th month after the adjuvant therapy, but he refused to receive treatment and remained out of follow-up. The patient presented with complaints of decreased vision and light flashes in his eye 21 months after the diagnosis. Management and outcome: Ocular examination revealed a choroidal mass and radiologically choroidal and multiple brain metastases were detected. In our case, whole-brain radiotherapy was administered in the treatment since there were also multiple brain metastases. However, as the ECOG (Eastern Cooperative Oncology Group) performance status of the patient was 3-4 after radiotherapy, systemic treatment was not considered appropriate, and the best supportive care was given. The patient died 2 months after the diagnosis of choroidal metastasis. Conclusion: Currently, there are few suggestions in case reports regarding appropriate treatment approaches for the treatment of rectal cancerchoroidal metastases. Multidisciplinary approaches may be effective for local and systemic treatment. Our case highlights a pathological entity with poor prognosis, which is rarely encountered during the course of rectal adenocarcinomas, and it is the first case of choroidal metastasis reported from our country. However, we believe that it will be important to draw attention to the fact that it is the first reported case of choroid metastasis in a rectal cancer patient with a BRAF V600 E mutation, and patients with BRAF V600 E mutation may develop metastasis to atypical areas due to their aggressive biology.

Risk factors of congenital anomalies of the kidney and urinary tract (CAKUT): Exposure to mobile phones during pregnancy.

Background/aim: Congenital anomalies of the kidney and urinary tract(CAKUT) are the leading causes of childhood chronic kidney disease (CKD). The etiology of most of the cases is thought to be multifactorial. In this study, risk factors for CAKUT and the effect of mobile phone-related electromagnetic field (EMF) exposure during pregnancy were investigated. Materials and methods: Fifty-seven cases and 57 healthy controls under 2 years of age were included and their mothers were subjected to a questionnaire. Groups were compared for parents' demographics, pregestational (chronic disease, body mass index, use of the folic acid supplements) and antenatal variables (gestational disease, weight gain during pregnancy,) and exposures during pregnancy. To assess mobile phone-related radiation exposure, all participants were asked about their daily call time, the proximity of the phone when not in use, and the models of their mobile phones. The specific absorption rate (SAR) of the mobile phones and the effective SAR value (SAR × call time) as an indicator of EMF exposure were recorded. Results: Excess weight gain according to BMI during pregnancy was related to an increased risk of CAKUT (p=0.012). Folic acid use before pregnancy was protective for CAKUT (p = 0.028). The call time of mothers of the CAKUT group was significantly longer than the control (p = 0.001). An association was observed between higher effective SAR values and increased risk of CAKUT (p = 0.03). However the proximity of the mobile phone to the mother's body when not in use was not found as a risk factor. Conclusion: The etiology of CAKUT is multifactorial. Our results suggest that prolonged phone call and higher EMF exposure during pregnancy increases the risk of CAKUT in the offspring.

Effect of systemic isotretinoin therapy on semen parameters.

PURPOSE: Vitamin A has multiple functions in the human body, being involved in growth, epithelial differentiation, vision, immune function and reproduction. While normal spermatogenesis is influenced by several factors, it requires vitamin A. Systemic isotretinoin is a vitamin A derivative that is used in the treatment of many dermatological diseases, especially acne vulgaris (AV). There is limited research on the changes in semen parameters after systemic isotretinoin therapy in humans. Our study investigates the presence of varicoceles in patients undergoing systemic isotretinoin therapy for AV and examines whether there were any changes in the semen parameters before and after treatment. METHODS: Included in the study were 46 men patients who were scheduled for systemic isotretinoin therapy for AV. Before treatment, the patients underwent a physical examination and ultrasonography for varicoceles assessment. The patients underwent spermiogram before treatment and after 6 months of treatment. The spermiogram assessments included semen volume, sperm concentration, total sperm count, progressive motility, viability and sperm morphology. RESULTS: After treatment, there was an increase in semen volume, sperm concentration, total sperm count, progressive motility and vitality from the pre-treatment values, but a deterioration in the sperm morphology (p < .05). Comparing patients with and without varicoceles revealed more changes in semen parameters after treatment in those with varicoceles. There was a statistically significant difference in sperm concentration (p < .001). CONCLUSIONS: Systemic isotretinoin therapy negatively affects sperm morphology, but has positive effect on other semen parameters, and these changes in semen parameters occur more frequently in patients with varicoceles.KEY MESSAGESAcne vulgaris is a very common disease and systemic isotretinoin is used as the most effective agent in its treatment.Systemic isotretinoin positively affects semen parameters except sperm morphology.Changes in semen parameters are more common in patients with varicocele.

Clinical implication of preoperative psoas muscle area in endometrial cancer patients.

OBJECTIVE: Obesity is a significant risk factor for endometrial cancer. In contrast, sarcopenia describes a loss of the body's muscle mass that is closely related to unfavorable clinical outcomes. Even endometrial cancer patients have high rates of obesity, and they should have a significantly higher risk for undiagnosed sarcopenia or fragile muscle quality. METHODS: This is a retrospective study that included an endometrial cancer database collected from a tertiary gynecologic cancer center. We investigated the relationship between preoperative psoas muscle area by magnetic resonance imaging, surgical outcomes and pathological features. RESULTS: The study included 116 patients, the mean height was 160 cm (Standart deviation 7), weight was 72 kg (Standart deviation 18), and the median duration of hospitalization was 4 days (Interquartile range 2-9) in the whole study group. Sarcopenia was diagnosed in 25 (21.6%) patients, according to the magnetic resonance imaging findings. Three (6.5%) obese patients had sarcopenia, but it was 31.4% in nonobese patients (p=0.026). The median duration of hospitalization was five days (3-9 days) in the sarcopenia group, and it was four days (2-7 days) in the non-sarcopenia group. CONCLUSION: Sarcopenic patients did not have increased surgical complication rates following uterine cancer surgery. We should be aware of hospitalization duration in those patients, and sarcopenic counterparts necessitate longer follow-up after the surgery.

Quantitative computed tomography analysis of emphysema severity and distribution in chronic obstructive lung disease, correlation with clinical findings.

INTRODUCTION: This study aimed to evaluate the correlation between different densitometric parameters on chest computed tomography (CT) and pulmonary function tests (PFT) of patients with emphysema-predominant chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: A retrospective evaluation was made of 56 patients with COPD. The lungs were segmented into nine sections. Normal and emphysematous parenchyma were measured using low attenuation area percentage (%LAA), percentile density (PD), and mean lung density (MLD) parameters. The effects of emphysema distribution on PFT were evaluated using %LAA, PD, MLD, kurtosis and skewness methods. RESULT: Fifty-six patients, all diagnosed with COPD, were evaluated. The %LAA-910 method showed significant correlation with forced expiratory volume in one second (FEV1) compared to other densitometric parameters (p= <0.001, r= -0.556). Other densitometric parameters differed between segments in terms of sensitivity for FEV1. It was determined that right lung mid-zone segment involvement affected FEV1 more than other segments when the %LAA -910 method was used (p= <0.001, r= -0.569). %LAA -950 had the largest area under the curve in ROC curve analysis and was determined to have 2.2% diagnostic property for predicting Global Initiative for Obstructive Lung Disease (GOLD) AB-CD staging (sensitivity 81%, specificity 74%). CONCLUSIONS: Quantitative analysis is an objective method for determining the distribution and severity of emphysema. There was a significant correlation between densitometry and PFT values. Quantitative analysis may be considered suitable for use in evaluating the severity of emphysema and predicting the clinical findings of patients.

Evaluating incidence and clinical importance of renal vein anomalies with routine abdominal multidetector computed tomography.

PURPOSE: Renal vein anomalies are usually asymptomatic embryological developmental disorders. If unidentified, they can lead to significant morbidity during surgical explorations. This study aims to evaluate the type, frequency, clinical importance of renal vein anomalies in patients scanned with Multidetector Computed Tomography (MDCT). It was also investigated whether renal vein anomalies are associated with malignancies or their types. METHODS: Abdominal MDCT images of 8517 patients were examined retrospectively. Renal vein anomaly types, gender, age, and symptoms were recorded. Renal vein anomalies were divided into three subgroups as retroaortic left renal vein (RLRV), circumaortic left renal vein (CLRV), and double right renal vein (DRRV). The presence of malignancy and their types in patients with renal vein anomalies were noted. Malignancies were divided into five subgroups as lung, gastrointestinal system (GIS), genitourinary system, breast, and others. RESULTS: 156 patients had renal vein anomaly (1.8%). The prevalence of RLRV, CLRV, and DRRV were 1.1%, 0.3%, and 0.2%, respectively. Renal vein anomalies were more frequent in females. Malignancy was present in 89 (57.1%) out of 156 renal vein anomaly patients. Among these 89 patients, RLRV was found in 52 (58.4%), CLRV in 22 (24.7%), and DRRV in 15 (16.8%) patients. The presence of malignancy was present in more than half of the renal vein anomaly patients but there was no significant correlation (p = 0.1). This high ratio is probably due to the high number of cancer patients undergoing CT scan in our radiology department. CONCLUSIONS: Renal vein anomalies are rare conditions, however, coexistence of renal vein anomalies and malignancies is not. An awareness of this entity before retroperitoneal surgeries is very important in order to avoid complications such as hemorrhage, transfusion, death, or conversion to open surgery.

Cholecysto-Hydatid Cyst Fistula: A Rare Cause of Cholangitis.

BACKGROUND Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. CASE REPORT A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. CONCLUSIONS We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

Magnetic Resonance Imaging Findings of Bilateral Cystic Neuroblastoma: Case Report of a Very Rare Entity.

Neuroblastoma (NB) is the most common solid tumor seen in children under two years old. It has both solid and cystic forms. It generally involves the adrenal gland unilaterally. Only 10% of the NBs are as seen bilateral. Both bilateral and cystic forms of NB are a very rare entity. Magnetic resonance imaging (MRI) is a suitable imaging modality for evaluating lesions radiologically to avoid ionizing radiation exposure in children. Herein, we present the MRI findings of a bilateral cystic NB case.

Multiple Pyogenic Liver Abscesses Mimicking Metastatic Disease on Computed Tomography.

Liver abscesses are divided into two main subgroups: pyogenic and nonpyogenic abscesses. Early diagnosis is important for appropriate treatment and to reduce the morbidity and mortality rates in liver abscesses. We report a case of multiple pyogenic liver abscesses mimicking liver metastases on multidetector computed tomography (MDCT). The case is unique as it shows a rare presentation of pyogenic liver abscess that cannot be distinguished from metastatic liver disease. Microbiologic and pathologic correlations with follow-up may be necessary for these patients. The case is presented with an emphasis on the MDCT findings.

Acute necrotizing encephalopathy secondary to diphtheria, tetanus toxoid and whole-cell pertussis vaccination: diffusion-weighted imaging and proton MR spectroscopy findings.

We present a previously healthy 6-month-old boy who was admitted to our hospital with lethargy, hypotonia and focal clonic seizures 6 days following diptheria, tetanus toxoid and whole-cell pertussis vaccination. A diagnosis of acute necrotising encephalopathy was made with the aid of MRI, including diffusion-weighted imaging and proton MR spectroscopy.

MRI of recurrent isolated cerebral Whipple's disease.

Whipple's disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipple's disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipple's disease in a 68-year-old man with atypical presentation and MRI findings.

Tissue Doppler study of the right ventricle with a multisegmental approach: comparison with cardiac magnetic resonance imaging.

OBJECTIVE: We investigated whether systolic right ventricular (RV) function and myocardial performance index (MPI) studied with a multisegmental approach improve the accuracy of RV function estimation based on tricuspid lateral annulus. METHODS: Systolic and isovolumic contraction velocities, isovolumic acceleration, regional MPI from the tricuspid lateral and septal annulus, and basal and apical RV free wall and blood pool MPI were obtained in 69 patients and compared with RV ejection fraction (EF) by cardiac magnetic resonance. RESULTS: Average systolic velocity from 2 annular sites had the highest correlation to the RVEF (r = 0.74; P < .001) and highest accuracy to estimate RVEF > 45% (cutoff = 7.0 cm/s; area under the curve 0.908; 95% confidence interval, 0.84-0.98; sensitivity 83%; specificity 86%; P < .0001). Average annular systolic velocity correlated with the RVEF more strongly than the lateral annular systolic velocity in patients with and without dilated RVs and in patients with and without pulmonary arterial hypertension. Four-region average MPI correlated with the RVEF (r = 0.70; P < .001) more strongly than regional MPI and blood pool MPI, with a higher accuracy to estimate RVEF > 45% (cutoff = 0.66; area under the curve 0.849; 95% CI, 0.76-0.94; sensitivity 86%; specificity 75%; P < .0001). Lateral annular measurements were mostly determined by the RVEF, whereas septal annular measurements were almost equally influenced by RVEF and left ventricular ejection fraction (LVEF). Consequently, when the RVEF and LVEF were discordant, only the lateral annular systolic velocity and MPI determined RVEF. CONCLUSION: Average systolic velocity from 2 tricuspid annular sites provides the most accurate estimate of RVEF if the RVEF and LVEF are not discordant.

Ultrasound and computed tomography findings of spontaneous intramural hemorrhage of renal pelvis and ureter in patient with hemophilia a.

Intramural renal pelvic and ureteral hemorrhage is seen most commonly in patients treated with anticoagulant therapy. However, spontaneous intramural hemorrhage of the ureter seen in patients with hemophilia is a rare entity and has been reported only in 2 cases. Computed tomography is a valuable imaging method in the diagnosis and follow-up. We report the ultrasound and computed tomography findings of spontaneous intramural renal pelvic and ureteral hemorrhage in a patient with hemophilia A.

Postpartum sacral stress fracture: an unusual case of low-back and buttock pain.

Low-back and buttock pain is a common complaint during pregnancy and the postpartum period and is usually attributable to mechanical lesions of the pelvis. Sacral stress fractures are unusual but important causes that should be considered in differential diagnosis. To date, only eight postpartum sacral stress fractures have been reported in the literature. A 32-yr-old woman presented with low-back and right buttock pain that started 15 days after uneventful cesarean section delivery. Imaging studies revealed a right sacral stress fracture. Lumbar spine and femoral neck bone mineral density were normal and, except for pregnancy and lactation, no risk factors for osteoporosis were identified. There was no history of trauma, excessive weight gain, strenuous physical activity, or contribution of mechanical factors. The question remains whether this is an insufficiency fracture or a fatigue fracture. Clinicians should consider sacral fracture during pregnancy and the postpartum period as a diagnostic possibility in patients with low-back and/or buttock pain.

An uncommon cause of acute abdomen--epiploic appendagitis: CT findings.

Epiploic appendagitis, which is an uncommon cause of acute abdomen, is a benign self-limiting inflammatory process of epiploic appendices. It has primary and secondary types. Computed tomography findings of the primary type are specific but are demonstrated rarely. Herein, we present pre- and post-treatment computed tomography findings of two cases who admitted to the emergency clinic with acute abdominal pain and were diagnosed to have epiploic appendagitis. Follow-up computed tomography features correlated well with clinical improvement.