Evaluation of distal tibial epiphysis and calcaneal epiphysis according to the Vieth method in 3.0 T magnetic resonance images: a pilot study.

In forensic medicine practice, age estimation-both in living and deceased individuals-can be requested due to legal requirements. Radiologic methods, such as X-rays, for the estimation of bone age have been discussed, and ethical concerns have been raised. Given these factors, radiologic methods that reduce radiation exposure have gained importance and have become one of the research topics in forensic medicine. In this study, the MR images of the ankles of patients aged between 8 and 25 years, obtained with a 3.0 T MR scanner, were evaluated retrospectively according to the staging method defined by Vieth et al. In the study, the ankle MR images of 201 cases (83 females and 118 males) with sagittal T1-weighted turbo spin echo and T2-weighted short tau inversion recovery sequences were evaluated independently by two observers. According to the results of our study, the intra- and inter-observer agreements are at a very good level for both the distal tibial and calcaneal epiphyses. All the cases detected as stages 2, 3, and 4 in both sexes for both the distal tibial and the calcaneal epiphyses have been determined to be under the age of 18 years. According to the data obtained from our study, we consider that stage 5 for males and stage 6 for both sexes in the distal tibial epiphysis and stage 6 for males in the calcaneal epiphysis can be used to estimate the age of 15 years. As far as we know, our study is the first to evaluate ankle MR images with the method defined by Vieth et al. Further studies should be conducted to evaluate the validity of the procedure.

PFP-HOG: Pyramid and Fixed-Size Patch-Based HOG Technique for Automated Brain Abnormality Classification with MRI.

Detecting neurological abnormalities such as brain tumors and Alzheimer's disease (AD) using magnetic resonance imaging (MRI) images is an important research topic in the literature. Numerous machine learning models have been used to detect brain abnormalities accurately. This study addresses the problem of detecting neurological abnormalities in MRI. The motivation behind this problem lies in the need for accurate and efficient methods to assist neurologists in the diagnosis of these disorders. In addition, many deep learning techniques have been applied to MRI to develop accurate brain abnormality detection models, but these networks have high time complexity. Hence, a novel hand-modeled feature-based learning network is presented to reduce the time complexity and obtain high classification performance. The model proposed in this work uses a new feature generation architecture named pyramid and fixed-size patch (PFP). The main aim of the proposed PFP structure is to attain high classification performance using essential feature extractors with both multilevel and local features. Furthermore, the PFP feature extractor generates low- and high-level features using a handcrafted extractor. To obtain the high discriminative feature extraction ability of the PFP, we have used histogram-oriented gradients (HOG); hence, it is named PFP-HOG. Furthermore, the iterative Chi2 (IChi2) is utilized to choose the clinically significant features. Finally, the k-nearest neighbors (kNN) with tenfold cross-validation is used for automated classification. Four MRI neurological databases (AD dataset, brain tumor dataset 1, brain tumor dataset 2, and merged dataset) have been utilized to develop our model. PFP-HOG and IChi2-based models attained 100%, 94.98%, 98.19%, and 97.80% using the AD dataset, brain tumor dataset1, brain tumor dataset 2, and merged brain MRI dataset, respectively. These findings not only provide an accurate and robust classification of various neurological disorders using MRI but also hold the potential to assist neurologists in validating manual MRI brain abnormality screening.

Smartphone evaluation of postero-anterior chest x-rays: An inter-observer study.

BACKGROUND: Posterior-anterior chest x-ray (PA-CXR) is among the most commonly used imaging methods in the diagnosis both in the emergency departments (ED) and the other clinics. The aim of the present study was to evaluate the diagnostic reliability of PA-CXRs sent via a smartphone. METHODS: This study was conducted as an inter-observer study. PA-CXRs were photographed with a smartphone and they were sent to two separate participants (emergency medicine specialists one with 4 years experience and another with 3) via the WhatsApp application. And the participants evaluated to these images on their mobile phone. RESULTS: A poor concordance was determined in a ratio of 3/8 and good concordance was detected in a ratio of 3/8 between the two participants (p < 0.05). It was observed that only the mediastinum assessments could be an alternative to the gold standard (p < 0.01). CONCLUSION: We may conclude that the assessments done via a smartphone (photographing and sharing) may not be reliable.

Pregnancy-Related Cardiovascular Complications: Case Presentation and Review of Literature.

BACKGROUND: Cardiovascular complications that can cause severe catastrophic outcomes for both the mother and the fetus are rarely seen during pregnancy. Time to diagnosis is often delayed by a low degree of suspicion and atypical presentation. We report surgical strategies in three pregnant women with cardiovascular complications. METHODS: A retrospective search from 2009 to 2016 identified three pregnant women who underwent urgent cardiac surgery. We used extracorporeal circulation (ECC) without cesarean section with careful follow-up of the fetuses during the perioperative and postoperative period. We used levosimendan as a potent inodilator in all patients to increase feto-placental blood flow and fetal heart rhythm. RESULTS: Median time to diagnosis was 23.8 h (range 11.7-120 h) and median time from diagnosis to arrival in the operating theater was 9.8 h (range 7.4-19.8 h). One patient with prosthetic heart valve thrombosis underwent concomitant cesarean section prior to cardiac surgery. In a young pregnant woman who had spontaneous dissection of the left anterior descending artery, on-pump beating heart coronary artery bypass grafting was performed without cross clamping. Two and three months after surgery, cesarean sections were performed without any complication in two pregnant women. CONCLUSION: Because unusual cardiovascular complications are the main cause of maternal and/or fetus death during pregnancy, prompt and exact diagnosis is very important. Life-saving surgical strategy with the help of appropriate teams are necessary to optimize outcome for both mother and baby.

Levosimendan Use Increases Cardiac Performance after Coronary Artery Bypass Grafting in End-Stage Renal Disease Patients.

BACKGROUND: The effect of levosimendan on myocardial performance has not been studied in dialysis-dependent end-stage renal disease patients who have undergone coronary artery bypass grafting (CABG) surgery. Our aim was to investigate the effect of levosimendan on postoperative hemodynamic effects in end-stage renal disease patients undergoing CABG operation. METHODS: We performed 58 elective isolated CABG operations in end-stage renal disease patients. The study group received levosimendan at a slow bolus dose of 3 µg/kg, followed by a 24-hour infusion of 0.03-0.05 µg/kg/kg/min. (study group [SG]: n = 25). The remaining patients received a placebo (control group [CG]: n = 33). The mean left ventricular ejection fraction of both groups was similar (44.6 ± 55.4% versus 42.8 ± 53.9%). Hemodynamic data were collected at the end, at 1 hour after CPB, and thereafter at 6, 12, and 24 hours in the ICU. Preoperatively, at the end of the operation, at 1 hour after CPB, and thereafter at 6, 12, and 24 hours in the ICU, blood samples from the peripheral vein were collected for cardiac troponin-I (c-TnI) and lactate levels. Norepinephrine if needed started during the rewarming period in both groups. RESULTS: One patient in SG (4%) and 4 patients (12.1%) in CG died postoperatively (P < .01). Cardiac output and cardiac index values did not change early after weaning from extracorporeal circulation, and they were nearly similar during the next 6 hours in both groups. In SG, cardiac output and cardiac index significantly improved at 6 hours, and were stable at the end of 24 hours (P < .001). Hemodynamic parameters were nearly similar after the operation, and did not change significantly at the end of 24 hours in CG. Hemodynamic improvement caused a significant reduction in systemic and pulmonary artery vascular resistance index in SG (P < .002). Pulmonary capillary wedge pressure decreased significantly in SG (P < .034). Cumulative inotrope dose requirement and intraaortic balloon pump use were significantly lower in SG. In addition, blood lactate and cTnI levels were significanly lower in SG (P < .044). CONCLUSION: No important adverse effect was detected during levosimendan infusion. Because levosimendan at a dose of 0.03-0.05 µg/kg/min increased myocardial performance significantly in the postoperative period, it can be used safely in end-stage renal disease patients undergoing isolated CABG. The requirement of vasopressors were lower in SG.

Evaluation of the Relationship Between Radial Artery Intima Media Thickness and Complications at the Intervention Site After Radial Angiography.

The present study investigated the relationship between pre-procedural radial intima-media thickness (rIMT) and radial artery thrombosis (RAO) in patients undergoing angiography using a transradial approach (TRA). Patients (n = 90) who underwent cerebral or peripheral arterial angiography using TRA were included in the study. Ultrasonographic evaluation was performed before and 12 h after the procedure. Preoperative rIMT measurement was performed at the distal radial artery. Presence of radial artery occlusion was evaluated by ultrasonography after radial catheterization and revealed occlusive thrombus in the radial artery in 13 patients. rIMT was found to be statistically significantly higher in patients with thrombus (P < .05). When it was evaluated whether there was a correlation between age and rIMT, a positive significant correlation was found (P < .01). Our study suggests that increase of rIMT may be a risk factor for RAO in the intervention area. Before the procedure, ultrasound (US) assessment of the radial artery may be useful in determining the risk of occlusion. Thus, RAO-related technical risk factors (procedure time, number of punctures, sheath thickness, etc.) can be managed more carefully in patients having radial angiography.

Evaluation of distal femoral and proximal tibial epiphyseal plate in bone age estimation with 3.0T MRI: a comparison of current methods.

OBJECTIVE: Dedouit et al, Kramer et al and Vieth et al defined different staging methods over different sequences in knee MRI for bone age determination. Our study aims to examine three different methods in which the maturation stages of the knee epiphyses are evaluated by MRI in the same population, to compare the methods and results and evaluate them for some age thresholds and to discuss their applicability in forensic age estimation. METHODS: In this study, 597 knee images obtained using a 3.0T MR scanner were evaluated retrospectively. The T 1 weighted and proton density-weighted sequences were evaluated by two observers. Knee bone development was staged on the femur and tibia, and descriptive statistics were calculated for each stage according to age and sex. Descriptive statistics were presented according to the age and sex of the cases, and intra- and interobserver agreements were evaluated by the κ and κw statistics obtained by the Fleiss approach. RESULTS: Significant changes were found in stages depending on age. The intra- and interobserver agreement levels were very good (κ > 0.80) for each method. The methods of Dedouit, Kramer and Vieth can be used as an additional criteria for forensic age estimation for 14, 15, 18 and 21 year thresholds. CONCLUSION: Knee MRI stands out as an alternative modality for age estimation and it is necessary to prefer the method intended for the investigated age range with an individual-specific approach. ADVANCES IN KNOWLEDGE: Our study stands out as the first study in which current classification methods were applied and compared in the same population for age estimation with knee MRI.

Intergenerational transmission of psychological trauma: A structural neuroimaging study.

Traumatic events have an important effect in human life and may lead to psychopathological disturbances by affecting the personal and social lives of individuals. Recently, various studies have been reported in the literature showing that the traumatic experiences may be associated with intergenerational psychopathologies. However, there is limited data regarding the neuroimaging studies investigating changes in brain structures in children of traumatized mothers. In this study, we aimed to investigate the potential changes in the hippocampus and amygdala volumes in the children of mothers exposed to mass trauma. The traumatic event experienced by the mothers was the two devastating earthquakes they experienced when they were teenagers. Hippocampus and amygdala volumes were evaluated in magnetic resonance imaging of 40 children whose mothers were exposed to earthquakes and 27 children in control group. Bilateral amygdala volumes were significantly smaller in the children of mothers exposed to earthquake compared to the control group. In addition, right amygdala and hippocampus volumes were smaller in children of mothers exposed to earthquakes than left. This is one of the pioneering neuroimaging studies on the intergenerational transmission of trauma. Our study shows that there may be a potential relationship between intergenerational trauma and various brain structures.

Evaluation of proximal humeral epiphysis ossification in 3.0 T MR images according to the Dedouit staging method: Is it be used for age of majority?

Magnetic resonance imaging (MRI) for forensic age estimation is among the research issues since it does not lead to radiation exposure. In this study, the ossification stage of the proximal humeral epiphysis was determined retrospectively in 178 male and 109 female individuals in the 12 to 30-year age group using 3.0 T MRI. All images were evaluated with the proton density fat saturated turbo spin echo (PD TSE FS) sequence and the T2 TSE FS sequence. A five-stage scoring system was used following the method of Dedouit et al. The relevant statistics were defined as minimum, maximum, mean ± standard deviation, 95% confidence interval of mean and median and the intra- and interobserver agreement levels were very good (κ > 0.80). There were no significant age differences between males and females in any of the stages (all p-values>0.05). According to the present study, stage 5 was initially observed at age 22 years for both genders. According to our results, it is possible to determine the completion of the 18th year of life in either gender on the shoulder joint. Proximal humeral epiphysis ossification may be used as an additional method for forensic age estimation through MRI.

Posterior shoulder labrocapsular structures in all aspects; 3D volumetric MR arthrography study.

Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies have been associated with traumatic posterior dislocation. A smaller portion of the lesions include posterior extension of superior labral anteroposterior lesions, posterior superior internal impingement, and damage to the posterior band of the inferior glenohumeral ligament. Labrocapsular anatomic variations of the posterior shoulder joint can mimic labral pathology on conventional MR and occasionally on MR arthrographic images. Knowledge of this variant anatomy is key to interpreting MR images and studying MR arthrography of the posterior labrocapsular structure to avoid misdiagnosis and unnecessary surgical procedures. In this article, we review normal and variant anatomy of the posterior labrocapsular structure of the shoulder joint based on MR arthrography and discuss how to discriminate normal anatomic variants from labrocapsular damage.

Applicability of 3.0 T MRI images in the estimation of full age based on shoulder joint ossification: Single-centre study.

Skeletal maturity is evaluated by many radiological methods for forensic age estimation. Direct radiography and computed tomography lead to a rise in ethical concerns due to radiation exposure. Therefore, magnetic resonance imaging (MRI) has currently been used in recent studies. In this study, the ossification stage of the shoulder joint was determined retrospectively in 178 male and 109 female individuals in the age group 12 to 30 years using 3.0 T MRI. All the images were evaluated with T1-weighted turbo spin echo (T1 TSE) sequence and T1 fast low angle shot two-dimensional sequence (T1 FL2D). The combined staging method, which was defined by Kellinghaus et al. and Schmeling et al., was used. The intra- and inter-observer agreement levels were very good (κ and κw). There were no significant age differences between males and females in all stages. In most of the stages, the ossification of the proximal humeral epiphyses occurred earlier in females than in males. Stage 4 did not occur in either of the sexes before the 18th birthday as the youngest patients in this stage was at 19 and 18 years of age in males and females, respectively. We concluded that evaluating the ossification of the proximal humeral epiphysis with MRI imaging for forensic age estimation may be beneficial. Evaluating the same anatomical structure with different MRI sequences may be useful for accurate staging diagnosis.

A Very Rare Cause of Lower Limb Ischemia in Young People: Popliteal Artery Entrapment.

BACKGROUND: Popliteal artery entrapment syndrome (PAES) is a very rare pathology that can cause lower extremity ischemia in healthy young people. Anomalous anatomic relationships between the popliteal artery (PA) and the surrounding musculo-tendinous structures cause PAES. We present 31 patients with PAES in 35 limbs that were treated surgically in our clinic within a 12-year period. PATIENTS AND METHODS: From 2001 to 2015, 31 patients (mean age: 32 ± 7.4 years) underwent surgery for PAES. ; 4 patients presented had bilateral PAES. Doppler ultrasonography (US), magnetic resonance angiography (MRA), and conventional angiography were performed as diagnostic procedures. We detected Type I PAES in 4 limbs and Type II PAES in 12 limbs. In the remaining 19 limbs, we diagnosed Type III or Type IV PAES. Simple release of the PA, PA embolectomy and simple release, and the radial artery (RA) patch angioplasty, with or without thromboendarterectomy (TEA), were performed. In 12 limbs, PA continuity was provided by RA interposition. RESULTS: With the exception of 5 patients, no complications were seen after surgery. Haematoma was detected in 2 patients and local infection in 2 patients. One patient required a revision for recurrent PA thromboembolic event 12 h after surgery. At a median follow- up of 23 months (range: 11-29 months), there were no postoperative complications. CONCLUSIONS: PAES can result in lower limb ischemia due to chronic vascular trauma in young healthy patients. The use of diagnostic tools such as US, a non-invasive method, and MRA are effective diagnostic tools for early diagnosis. With their combined approach, exact and early diagnosis can be achieved. PA release, alone or with arterial bypass using RA, is a viable treatment option when intervention is necessary to prevent limb loss in the early stages of the disease.

A complication of thyroidectomy: Do not forget suture reaction.

OBJECTIVE: In this study, we aimed to present patients who have developed suture reaction and were treated in our clinic following thyroidectomy operation. MATERIAL AND METHODS: Patients who had been treated for suture reaction following thyroidectomy between January 2012 and December 2014 were retrospectively evaluated. The patients were analyzed in terms of their age, gender, duration of the symptoms, type of previous operation and treatment modality. RESULTS: Between January 2012 and December 2014, 559 thyroid/parathyroid operations were performed in our clinic. A total of 12 patients were admitted with suture reaction within this period thus yielding a suture reaction incidence of 2.1%. The mean age of these patients was 42±7.65 years, 75% of them were female while 25% of them were male. The types of previous operations were bilateral total thyroidectomy in 83.3%, lobectomy in 8.3% and near total thyroidectomy in 8.3% of the patients. The mean symptom duration was 7.2±4.3 (2-16) months. Two patients (16.7%) underwent a second surgical operation for suture reaction, while 10 patients (83.3%) were treated conservatively. None of the patients developed complications. CONCLUSION: One of the most common complications that develop after thyroidectomy is bleeding. Ligation must be performed in order to prevent this complication. As it is known, surgical ligation with sutures may cause tissue reaction. Sutures that are absorbable and have a low risk for reaction formation should be chosen if suturing is preferred.

Familial Abdominal and Intestinal Lipomatosis Presenting with Upper GI Bleeding.

Although lipomas are encapsulated benign tumors, systemic lipomatosis defines infiltrative nonencapsulated tumors resembling normal adipose tissue. Abdominal lipomatosis and intestinal lipomatosis are different clinicopathological entities with similar clinical symptoms. We describe here a case presenting with upper gastrointestinal bleeding from eroded submucosal lipoma at duodenum secondary to intestinal lipomatosis and abdominal lipomatosis.

Ingested bone fragment in the bowel: Two cases and a review of the literature.

Generally, ingested foreign bodies are excreted from the digestive tract without any complications or morbidity. In adults, ingestion of foreign bodies frequently occurs in alcoholics and elderly individuals with dentures. The most commonly ingested foreign bodies are food stuffs or their parts, such as fish bones or fragments of bone and phytobezoars. Sharp foreign bodies like fish and chicken bones can lead to intestinal perforation and peritonitis. We report herein two cases, one of bowel perforation and another of anal impaction, both caused by ingested bone fragments. Complications due to ingested bone fragments are not common and preoperative diagnosis remains a challenge and therefore it must be considered in susceptible cases.

[Loeffler's syndrome mimicking bronchial asthma and pneumonia in a child: case report]. / Çocukluk çaginda astim ve pnömoniyi taklit eden Löffler sendromu: olgu sunumu.

A 14-year-old male child was hospitalized with complaints of a bronchial wheezing, cough, dyspnea, and sputum and a preliminary diagnosis of bronchial asthma and pneumonia. The patient was treated empirically for bronchial asthma and pneumonia, but gave neitherr clinical nor radiological response to treatment. On the high-resolution computerized tomography, a typical spiral image of Ascaris lumbricoides was identified inside a cavity in the upper lobe of the left lung with a diameter of 8x7 cm. Also,migratory pneumonic infiltrations progressing between the lower lobe and hilary region of the left lung were seen. Examination of the peripheral blood smear of the patient revealed eosinophilia (40%), while IgE was measured as 350 IU/mL. The patient was diagnosed as "Loeffler's syndrome" due to A. lumbricoides", and successfully treated with mebendazole 2x100 mg/day for three days. Loeffler's pneumonia should be considered when patients with bronchial asthma and pneumonia do not respond to specific treatment in developing countries. Radiological investigations may be available in the diagnosis of parasitic infections. In this case, early diagnosis by radiologic methods have prevented unnecessary drug use and related complications.

Littoral-cell angioma of the spleen.

Littoral-cell angioma (LCA) is a rare vascular tumor of the spleen. It was thought to be a benign, incidental lesion. However, many recent reports have described it to be a malignant lesion with congenital and immunologic associations. We report a case of LCA of the spleen, which has been infrequently communicated in the literature. A 41-year-old female patient was admitted to our hospital with a three-week history of weakness, weight loss, anorexia, and intermittent upper abdominal pain which improved slightly with antacid medication.Imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI), showed multiple lesions in the spleen. Laparoscopic splenectomy was performed.

[Primary disseminated pulmonary hydatid cyst manifesting with right-side cardiac failure: case report]. / Sag kalp yetmezligi bulgulari ile basvuran primer yaygin tutulumlu pulmoner kist hidatik: olgu sunumu.

Hydatid disease is a parasitic infection caused by a tapeworm of the genus Echinococcus. There are three known species of Echinococcus that lead to the disease among humans. E. granulosus is the most common of the three. A 26-year-old man admitted to emergency room with a cough, dyspnea, tachycardia, and chest pain was hospitalized with suspected pneumonia. The patient was in poor general condition and was conscious. On physical examination, fever: 37.3°C/axillary, blood pressure: 165/100 mmHg, cardiac pulse: 114/min, remarkable bilateral pretibial edema, peripheral cyanosis, and disseminated rales and rhonchi were found. Chest radiography showed the multiple disseminated cystic formations, and thorax computed tomography showed remarkable dilatation in the ring of pulmonary artery, and multiple cystic formations in the lung area. The disseminated pulmonary hydatid cyst disease was diagnosed according to clinical and laboratory findings. Albendazole 800 mg/kg daily was administered to the patient for three months. The patient recovered markedly after this treatment. To our knowledge, this is the first case of primary disseminated pulmonary hydatid cyst to manifest with right-side cardiac failure. In endemic areas, the morbidity and mortality due to hydatid cyst may be decreased if hydatid cyst is considered among patients with suspected radiologic findings.