Feasibility of virtual reality and comparison of its effectiveness to biofeedback in children with Duchenne and Becker muscular dystrophies.

INTRODUCTION/AIMS: The utilization of virtual reality (VR) and biofeedback training, while effective in diverse populations, remains limited in the treatment of Duchenne and Becker muscular dystrophies (D/BMD). This study aimed to determine the feasibility of VR in children with D/BMD and compare the effectiveness of VR and biofeedback in children with D/BMD. METHODS: The study included 25 children with D/BMD. Eight children in the control group participated in a routine follow-up rehabilitation program, while the remaining children were randomly assigned to the VR (n = 9) and biofeedback (n = 8) groups for a 12-week intervention. The following evaluations were performed before, during (week 6), and after treatment: Muscle pain and cramps, laboratory studies, muscle strength, timed performance, function (Motor Function Measurement Scale-32, Vignos, and Brooke Scales), and balance (Pediatric Functional Reach Test and Balance Master System). Motivation for rehabilitation was determined. RESULTS: The median ages were 9.00 (VR), 8.75 (biofeedback), and 7.00 (control) years. The study found no significant differences between groups in pretreatment assessments for most measures, except for tandem step width (p < .05). VR and biofeedback interventions significantly improved various aspects (pain intensity, cramp frequency, cramp severity, muscle strength, timed performance, functional level, and balance) in children with D/BMD (p < .05), while the conventional rehabilitation program maintained patients' current status without any changes. The study found VR and biofeedback equally effective, with VR maintaining children's motivation for rehabilitation longer (p < .05). DISCUSSION: The study showed that both VR and biofeedback appear to be effective for rehabilitation this population, but additional, larger studies are needed.

Comparison of Hospitalization Rate and Social Functioning of Patients Receiving Community Mental Health Service and Outpatient Psychiatry Policlinic.

BACKGROUND: This study aimed to compare the hospitalization rates and social functioning of patients receiving Community Mental Health Center (CMHC) services and those treated in the psychiatry policlinics of hospitals. SUBJECTS AND METHODS: A total of 145 patients who were diagnosed with schizophrenia or schizoaffective disorder according to DSM-V criteria were included in the study. Of them, 81 received CMHC services at least for one year (CMHC group) and 64 were followed-up in psychiatry policlinics (hospital group). A personal information form containing socio-demographic and disease/treatment characteristics and hospitalization counts in the last year, Social Functioning Assessment Scale (SFAS) and Positive and Negative Syndrome Scale (PANSS) were used to collect data. The hospital group received antipsychotic medication therapy while a semi-structured psycho-social intervention program combined with antipsychotic drug therapy was applied in the CMHC group. The hospitalization counts, SFAS and PANSS scores of the groups were compared and the correlation of related factors were evaluated. RESULTS: Hospitalization rates were 0.21±0.56 in the CMHC group and 1.03±1.31 in the hospital group. The mean hospitalization rate was significantly lower in the CMHC group (p<0.001). The mean scores for the overall SFAS and its interpersonal relationships and entertaining subscale; were significantly higher in the CMHC. The mean overall PANSS scores were 84.23±15.28 and 99.50±15.99 in the CMHC and hospital groups, respectively (p<0.05). There was a moderate positive relationship between hospitalization rates and all PANSS scores. CONCLUSIONS: CMHC services led to a serious decrease in hospitalization rates, increased the psychosocial functioning of patients and improved their compliance to treatment. Transition to a community-based mental health model should be accelerated for holistic treatment. Further longitudinal studies with a control group should be conducted.

Foetal biometry in polyhydramnios: Does femur length fall behind?

We aimed to identify the growth patterns in polyhydramnios, and therefore evaluated 108 singleton pregnancies complicated with polyhydramnios according to the changes in biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) percentiles. The pregnancy outcomes according to the growth features were analysed. In the study population, BPD and AC percentiles exhibited a significant increase (p = 0.023 and 0.05, respectively), although FL percentiles showed a significant decrease (p = 0.006) according to the changes in third trimester relative to second trimester. In the overgrown group (n = 52), the FL/BPD ratio was lower (p < 0.001), with more foetuses with FL/BPD ratios below 71 (p = 0.05). In conclusion, there was a significant increase in BPD and AC percentiles and a decrease in FL percentiles in third trimester relative to second trimester in foetuses with polyhydramnios. However, we observed a shorter FL and a lower FL/BPD ratio without associated skeletal dysplasia in overgrown foetuses.

Choroid plexus separation in fetuses without ventriculomegaly: Natural course and postnatal outcome.

PURPOSE: To evaluate fetuses with choroid plexus separation without ventriculomegaly in terms of fetal malformations, behavior of the separation during follow-up, and postnatal outcome. METHODS: In total, 172 fetuses with choroid plexus separation without ventriculomegaly were included in this prospective study. Fetal sonography was performed at 2- to 4-week intervals, and detailed physical and neurologic examinations were performed after their delivery. Fetuses were categorized into normal and abnormal subgroups according to the outcome. RESULTS: Sixteen fetuses (9.3%) were included in the abnormal-outcome group and 156 fetuses (90.7%) were included in the normal-outcome group. Both the initial mean lateral ventricular diameter (9.3 mm versus 8.6 mm) and the initial mean choroid plexus separation (4.8 mm versus 3.3 mm) were greater in the abnormal group than in the normal group (p < 0.001 for both comparisons). We found that 4.0 mm was the best cutoff point of choroid plexus separation to detect a major anomaly, with 87.5% sensitivity and 93.6% specificity. CONCLUSIONS: Choroid plexus separation without ventriculomegaly often resolves within the third trimester and does not affect postnatal outcome. It can be associated with various fetal malformations; however, with a comprehensive examination, all fetal malformations can be detected prenatally. Follow-up sonography studies would be useful, especially in the case of suspected corpus callosum agenesis.

[Angiographic evaluation of branching pattern and anatomy of the aortic arch]. / Arkus aorta anatomisinin ve dallanma paternindeki varyasyonlarin anjiyografik olarak degerlendirilmesi.

OBJECTIVE: The study aimed to investigate anatomical variations in branching pattern and anatomy of the aortic arch, and the prevalence of each type. METHODS: Between September 2011 and November 2013, angiographic studies of 270 patients (144 male, 126 female) were analyzed retrospectively for variations in branching pattern and anatomy of the aortic arch. Patient mean age was 59.8 years (range, 13-88). Branching variations were found and divided into subtypes. Patients were also classified according to arch anatomy. Incidence of variations and types of aortic arch were statistically analysed. RESULTS: Analysis of the 270 patients revealed six types of branching pattern. Type I, classical pattern arch with three branches (TB, LCC, LS), was observed in 198 cases (73.3%). Type II (bovine arch), the most commonly observed variation, in which LCC originates from TB, was observed in 58 cases (21.5%). Type III, in which the left vertebral artery arises from the arch, was seen in seven cases (2.6%). Type IV, a combination of types II and III, was observed in three cases (1.1%). Type V, common origin of common carotids, LS and aberrant RS, was found in three cases (1.1%). Type VI (avian type), arch with only two branches, was observed in one case (0.4%). When patients were classified according to aortic arch anatomy, Type 1, Type 2 and Type 3 were observed in 195, 40 and 35 patients respectively. CONCLUSION: Knowledge of the variations and anatomy of the aortic arch is essential during interventional procedures and neck-thorax surgery.

Evaluation of effects of bronchiectasis on bronchial artery diameter with multidetector computed tomography.

BACKGROUND: Among patients with increased bronchial artery diameter there is a significant association between hemoptysis and bronchiectasis score. The higher score of bronchiectasis, the higher risk of hemoptysis development. PURPOSE: To investigate the association of stages of bronchiectasis based on a computed tomography (CT) grading system, with bronchial artery diameter and hemoptysis in patients with bronchiectasis. MATERIAL AND METHODS: Patients with lung pathologies other than bronchiectasis, which may cause hemoptysis, were excluded from the study. One hundred and forty-five patients who underwent contrast-enhanced thorax CT by a 64-detector CT for various indications, and who were diagnosed with bronchiectasis, were evaluated retrospectively. CT examinations were carried out by two radiologists with 9 and 4 years of experience with chest radiology, respectively. The diameters of the right and left bronchial arteries were measured 1 cm from the aortic origin and perpendicular to the vessel axis. Cases were assessed based on the Bhalla CT scoring system. The hemoptysis history of every patient was taken. RESULTS: The diameters of the right and left bronchial arteries were significantly greater in patients with scores of 2 and 3 bronchiectasis than in patients with a score of 1. This was significantly greater in patients with a score of 3 than in patients with a score of 2 (P < 0.05). In patients with a score of 1, the right bronchial artery diameter was significantly greater than that of the left bronchial artery (P < 0.05). Right bronchial artery diameters were significantly greater than left bronchial artery diameters in score 3 patients (P < 0.05). A significant association was observed between hemoptysis and bronchiectasis in patients with increased bronchial artery diameter (P < 0.05). CONCLUSION: In patients with bronchiectasis, as the stage of bronchiectasis increases, the bronchial artery diameters and the risk of hemoptysis increase. We think that in patients who are diagnosed with bronchiectasis via multidetector CT (MDCT), based on scoring with bronchial artery diameters, the risk of hemoptysis can be estimated, and early management plans can be implemented.

The role of elastosonography, gray-scale and colour flow Doppler sonography in prediction of malignancy in thyroid nodules.

BACKGROUND: Ultrasound is as a noninvasive method commonly used in the work-up of thyroid nodules. This study aimed to evaluate the usefulness of sonographic and elastosonographic parameters in the discrimination of malignancy. PATIENTS AND METHODS: 150 thyroid nodules were evaluated by gray-scale, Doppler and elastosonography. The cytological analysis revealed that 141 nodules were benign and 9 were malignant. RESULTS: Orientation of the nodule was the only sonographic parameter associated with malignancy (p = 0.003). In the strain ratio analysis the best cut-off point was 1.935 to discriminate malignancy (p = 0.000), with 100% sensitivity, 76% specificity, 100% negative predictive value, 78.5% positive predictive value and 78% accuracy rate. There was a statistically significant correlation between the elasticity score and malignancy (p = 0.001). Most of the benign nodules had score 2 and 3, none of them displayed score 5. On the other hand, none of the malignant nodules had score 1 and 2, most of them displaying score 5. CONCLUSIONS: A change in the diagnostic algorithm of the thyroid nodules should be considered integrating the elastosonographic analysis.

The role of elastosonography in the differentiation of parotid gland lesions: report of three cases and review of the literature.

BACKGROUND: The parotid gland is the mostly affected site among major salivary gland tumors in up to 85% of cases. Preoperative knowledge of the tumour nature is crucial since it influences the surgical procedure and patient's morbidity, especially the risk of facial nerve palsy. Ultrasonography is commonly used as the first line imaging modality for the salivary gland lesions. A pitfall is that the histologic pleomorphism often reflects an imaging pleomorphism. CASE REPORT: HEREIN WE AIMED TO PRESENT THE ROLE OF ELASTOSONOGRAPHY IN THREE PAROTID LESIONS: a case of benign pleomorphic adenoma, a Wharthin's tumour and a malignant parotid tumour. CONCLUSIONS: Our findings show that malignant parotid lesion was the stiffest lesion according to elastosonography. Wharthin's tumour demonstrated soft elastosonographic features. The pleomorphic adenoma was also interpreted as stiff by elastosonography suggesting that the elastosonographic features of pleomorphic adenoma may resemble those of malignant lesions limiting the utility of the technique.

Dual task impact on functional mobility and interaction of functional level and balance in patients with Duchenne muscular dystrophy.

BACKGROUND: Dystrophin, a protein crucial for various brain regions governing higher-order functions like learning and memory is notably absent in individuals with Duchenne muscular dystrophy (DMD). This absence of dystrophin in the brain is believed to underlie cognitive challenges in DMD. Cognitive and motor challenges observed in DMD could potentially hinder the execution of dual tasks. RESEARCH QUESTION: Is there a significant correlation between dual-task performance, functional mobility, and balance in children with DMD? METHOD: The study included 28 participants (14 DMD, 14 typical development). Timed Up and Go (TUG) test results were recorded for single and dual-task conditions (motor-motor, cognitive-motor). Functional level was assessed using Motor Function Measurement-32 (MFM-32), Brooke Upper Extremity Scale, and Vignos Scale. Balance was evaluated using Balance Master System and Pediatric Functional Reach Test (PFRT). RESULTS: Significant differences in TUG test scores across conditions were observed in both DMD and typical development groups (p < 0.05). Children with DMD exhibited longer completion times compared to typical development children (p < 0.05). Among children with DMD, there was a significant correlation between TUG scores in different task conditions and balance assessment (p < 0.05, r = 0.571 to -0.819). Lower MFM-32 scores in DMD children were correlated with worse TUG performance across conditions (p < 0.05, r = 0.586 to -0.868). SIGNIFIANCE: This study sheds light on the multifaceted nature of dual-tasking challenges in individuals with DMD, thereby contributing to a deeper understanding of the implications for rehabilitation strategies.

The Impact of Parent-Based Support Programs on Neurodevelopmental Prognosis: Second-Year Results from a Newly Established Neurodevelopmental Follow-Up Unit in a Tertiary Hospital.

This study aims to assess the neurodevelopmental progress of high-risk infants 2 years post implementation of the Neurodevelopmental Follow-Up Unit (NFU) program at our hospital and explore implementation challenges for insights. Infants were assessed using the Hammersmith Infant Neurological Examination (HINE), The Alberta Infant Motor Scale (AIMS), and Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). A multidisciplinary team provided comprehensive parent education covering neurologic cues, postural advice, and developmental instructions in accordance with the children's assessment findings. In addition, a pediatric physical therapist provided motor development training emphasizing age-appropriate milestones and functional independence, while child development specialists addressed delays identified through BSID-III assessments. A total of 121 high-risk babies were enrolled during a 2-year period. Results revealed that 9 infants exhibited suboptimal HINE scores at 3-4 months, with only 2 maintaining suboptimal scores at 12-15 months. Similarly, 2 infants with suboptimal AIMS scores at 3-4 months reached normal values at 12-15 months. Comparable improvements were observed in BSID-III scores. While no correlation between HINE and AIMS scores was found at the 3-4-month mark, a significant correlation emerged between AIMS and HINE scores at 6-9 months (r = 0.643, P < .001) and 12-15 months (r = 0.820, P < .001). Encouraging early family education alongside regular monitoring of high-risk newborns appears to have a positive impact on their motor and cognitive development. Consideration of clinical recommendations, such as tailored interventions and periodic assessments, may contribute to optimizing developmental outcomes.

Efficacy of automatic pupillometry as a screening technique to detect autonomic dysfunction in bipolar disorder.

CLINICAL RELEVANCE: Autonomic nervous system abnormalities in the pathophysiology of bipolar disorder are controversial. Pupillary features may be affected as a result of autonomic nervous system abnormalities in bipolar disorder. Small changes in pupillary responses may not be noticeable on clinical examination. Automated pupillemetries can be helpful in demonstrating these changes reliably and quantitatively. BACKGROUND: The aim of this study was to compare the static and dynamic pupillary responses of bipolar patients with healthy controls. In addition, pupillary response differences between mania, depression and remission stages were investigated. METHODS: The bipolar patient group consisted of 39 eyes of 39 patients with 13 patients in each of the stages: mania, depression and remission. The control group consisted of 39 eyes of 39 healthy volunteers. After the ophthalmic examination, static and dynamic pupillometry measurements were made. The mean pupil dilatation speed was calculated according to dynamic measurements. Static pupillometry measurements including scotopic, mesopic and photopic pupil diameters; the first dynamic measurements at 0th second and pupillary dilatation speed were used for statistical analysis. RESULTS: There was no difference static and the first dynamic pupillometry measurements between the bipolar and control groups (p > 0.05 for all parameters), but there was a significant difference in mean pupil dilatation speed (p = 0.041). No significant differences were found between the 3 groups for all static and the first dynamic pupillometry measurements and the mean pupil dilatation speed (p > 0.05). CONCLUSION: Static and the first dynamic measurements of bipolar patients were not different from healthy controls. The mean pupil dilatation speed of bipolar patients was significantly lower, but this difference had a low effect size.

Optical Coherence Tomography Findings in Bipolar Disorder Patients and the Related Factors.

Background: This study's purpose is to determine the effects of current episode and the mood stabilizers on chorioretinal layer thicknesses of bipolar disorder (BD) patients using spectral-domain optical coherence tomography (SD-OCT). Methods: Sixty-seven patients were diagnosed with BD I and using lithium (Li) or valproic acid (VPA), of whom 20 were manic, 24 were depressive, and 23 were in remission, and 49 healthy individuals were included in the study. Peripapillary retinal nerve fiber layer (RNFL), ganglion cell layer, and macular thicknesses of the participants were measured automatically using SD-OCT, and their choroid layer thicknesses were measured manually using the depth imaging mode of SD-OCT. Statistical analysis of the data was performed using Statistical Package for the Social Sciences version 23.0. Results: The patient group's mean age was 39.78 ± 11.78, and the control group's mean age was 42.06 ± 12.10. The mean disease duration was 13.22 ± 8.23 in the patient group, and 26 patients were using Li. While peripapillary RNFL thicknesses were lower in the patient group (P < .05), other layer measurements were similar between the groups. Moreover, the episodes experienced by BD patients did not affect chorioretinal SD-OCT measurements. The patients on VPA had significantly lower RNFL thicknesses compared to the control and the Li groups, and all chorioretinal measurements were similar between the Li and the control groups. Conclusion: As a result of the study, it was established that neurodegenerative processes play a role in the pathophysiology of BD and the usage of Li is protective against the neurodegeneration of RNFL. Retinal changes measured with SD-OCT can be used for the diagnosis and prognosis of BD and for evaluating responses to mood stabilizers.

Recurrent Priapism Due to Paliperidone Palmitate Use: A Case Report.

Priapism is a painful and prolonged erection of the penis without sexual stimulation. Priapism can be seen due to both typical and atypical antipsychotic drug use. A 51-year-old male who was followed up with a diagnosis of schizophrenia for 30 years and was switched from oral aripiprazole to paliperidone palmitate due to psychotic exacerbation was reported in this study. About 1 month after starting the drug, the patient presented to the emergency department with a painful and prolonged penile erection lasting 3-4 hours. Following the diagnosis of priapism by urology, the patient was relieved by intracavernous adrenaline injection and corpus cavernosum drainage and was referred to psychiatric consultation. Since the patient's examination, history, and laboratory tests could not detect a condition that could cause priapism, it was thought that priapism might be due to antipsychotic medication. One week after stopping paliperidone palmitate injection, the patient had another attack of priapism. Ten days after the second priapism, the patient was started on olanzapine, 10 mg/day, which was increased to 20 mg/day in the follow-up. The patient has been using olanzapine 20 mg/day for the past year. He is still psychiatrically stable and has no signs of priapism. To the best of our knowledge, this is the second case of recurrent priapism associated with paliperidone palmitate use.

An Optical Coherence Tomography Study that Supports the Neurovascular Basis of Schizophrenia Disease.

Objectives: Spectral domain optical coherence tomography (SD-OCT) is a non--penetrating, quick, and practical device which enables measurement of the chorioretinal layers. In this study, our purpose was to investigate the retinal nerve fiber layer (RNFL) and choroidal thickness in schizophrenia patients, using SD-OCT, and compare the -findings with those of the control group. Methods: For the study, 44 patients with a diagnosis of schizophrenia, and 41 age- and gender- matched healthy controls were enrolled. Both eyes of each participant were -evaluated. RNFL was measured and analyzed automatically with optical coherence tomography. Scans for choroidal thickness were obtained with the enhanced depth imaging mode of the SD-OCT device and measured manually. Results: The average age of schizophrenia patients was 47.82, and it was 45.5 for the control group. The mean illness duration of the patients was 24.79 years. According to the results of this study, all choroidal measures (nasal, subfoveal, and temporal) of both eyes, and the RNFL thickness of schizophrenia patients, were significantly thinner than that of healthy controls. The chorioretinal measures of both eyes were similar. The results showed that a weak negative correlation was present between illness duration and choroidal diameter. Conclusion: In addition to demonstrating the thinning of RNFL in schizophrenia patients, as frequently reported in the literature, the results of this study show, for the first time, that choroidal thickness is considerably decreased in schizophrenia patients compared to the healthy controls, using SD-OCT. Keeping in mind that the choroid is a vascular layer, these results support the neurovascular hypothesis of schizophrenia.

Evaluation of fetal nasofrontal angle in the second trimester in normal pregnancies.

PURPOSE: The nasal bone is one of the important fetal structures to be radiologically evaluated in the first and second trimesters. In this study, we aimed to evaluate the nasal root and to determine the normal range of the naso-frontal angle, which may potentially be used as a predictive or diagnostic parameter in the diagnosis of the above-mentioned syndromes or other congenital abnormalities with associated nasal features using obstetric ultrasonography in normal fetuses. METHODS: We evaluated the naso-frontal angle using transabdominal ultrasonography in 195 healthy fetuses between the 18(th) and 21(st) weeks of gestation. The measurements were performed with the fetal neck in mild flexion and three echogenic lines (nasal end, skin on the nasal bone, nasal bone) visualized. RESULTS: The minimum, maximum and mean naso-frontal angle values were 110°, 143° and 128°, respectively, between the 18(th) and 21(st) weeks of gestation. Linear regression analysis showed no association between NFA and gestational week (Beta = 0.020 p = 0.786). CONCLUSIONS: The normal range of NFA between the 18(th) and 21(st) weeks of gestation was determined in this study. The association between NFA measurements and various congenital anomalies or fetal outcomes remains to be investigated.

CT findings of a thoracic vertebral hemangioma presenting with acute neurological symptoms.

Vertebral body hemangiomas are benign lesions and account for 4% of all spinal tumors. The most common histological type is cavernous hemangioma. These tumors generally locate in the vertebral body as a solitary lesion. Multiple lesions are seen in approximately 25-30% of vertebral hemangiomas. Mostly they are asymptomatic and incidentally found with radiological studies. Symptomatic vertebral hemangiomas are rare and represent < 1% of all hemangiomas; however, if untreated, they may cause local or radicular pain and neurological deficits ranging from myeloradiculopathy to paralysis. In this case we aim to present preoperative and postoperative Computed Tomography findings of a cavernous hemangioma that caused sudden motor deficit and was localised to the thoracic vertebra corpus and posterior elements.

Rates and correlates of employment in patients with schizophrenia: A multicenter study in Turkey.

BACKGROUND: There is not enough information regarding the participation in the working life of the patients with schizophrenia in Turkey. AIMS: The aim of this study was to examine the occupational experiences of patients with schizophrenia before and after the illness and to investigate the factors that predict work participation. METHODS: The data on occupational life of the patients with schizophrenia, which were treated as outpatients in six different centers, were examined. The rates of participation in working life before and after the disease were evaluated. Patients with and without occupational life history after the disease were compared in terms of demographic characteristics. Factors predicting participation in work life after the disease were analyzed by logistic regression analysis. RESULTS: Out of the 587 patients evaluated in the study, 73% were males, 73% were single, the mean age was 42, mean level of education was 9 years and the average duration of illness was 18 years. The duration of the employment before the disease was higher than that after the disease regarding expected working time. The rate of employment was 11% currently, 14% in the last year, 62% after the disease and 83% for the lifetime. While the factors that predicted to be in working life after the illness were male gender (odds ratio (OR) = 2.9), diagnosis of schizoaffective disorder (OR = 2.6), high level of education (OR = 1.2) and employment history before the onset of the illness (OR = 1.0), only the shorter duration of illness (OR = 1.1) predicted the current working status when the gender variable was excluded. CONCLUSION: Rate of employment of patients with schizophrenia living in Turkey was low as in other countries. Good premorbid functioning seems to determine participation in occupational life after the illness.

[Long term follow-up of patients with postpartum psychosis]. / Dogum ardi psikoz tanisi konulan hastalarin uzun süreli izlemi.

OBJECTIVE: This research compared the demographic features, presence of confusion, and long-term follow-up results of women with postpartum psychosis to control subjects. METHOD: The study included 23 patients with symptoms that emerged in the six-month period after delivery who were followed-up between 1998 and 2006. The control group consisted of 25 age- and education level-matched female patients experiencing their first psychotic episode. Data were collected with a sociodemographic questionnaire, the Clinical Global Impression Scale, and the Delirium Rating Scale. Final diagnoses were made according to DSM-IV. RESULTS: Among the postpartum women, 73.9% developed psychosis during their first parturition. The postpartum psychosis and control groups were followed-up for 4.00 +/- 1.62 (range: 2-6) and 3.96 +/- 1.24 (range: 2-6) years, respectively. During the follow-up period, 21.7% of the postpartum patients developed a mood disorder, and 77.9% developed schizophrenia and other psychotic disorders. Among those in the control group, 32.0% were diagnosed with a mood disorder and 68.0% with schizophrenia and other psychotic disorders. The distribution of final diagnoses in the 2 groups were similar. Patients with postpartum psychosis experienced more confusion than the control subjects. During the follow-up period, 65.2% of the patients with postpartum psychosis and 72% of the control patients had recurrence. CONCLUSION: The course of postpartum psychosis was similar to DSM-IV diagnostic criteria, except for the presence of confusion. During the follow-up period, most of the patients in both groups were diagnosed with schizophrenia and other psychotic disorders. This result indicated that there is no need for other diagnostic criteria for postpartum psychosis other than those presently contained in DSM-IV.

Importance of Sonoelastography in Assessing Non-Thyroid Neck Masses.

OBJECTIVE: To evaluate the feasibility and value of sonoelastography in assessing non-thyroid neck masses. METHODS: Non-thyroid neck masses requiring surgical interventions were evaluated using conventional B-mode ultrasonography (US) (size, short/long axis rate, shape, hilum, echogenity, calcification, necrosis, and peripheral edema) and sonoelastograpy (SE) with strain ratio (SR) and elasticity score (ES) before surgery. These parameters were compared with the histopathological examination. RESULTS: In total, 116 non-thyroid neck masses (66 lymph node, 35 parotid gland, eight submandibular gland, and seven cervical mass) of 89 patients (51 men, 38 women) with a mean age of 50.3±15.1 (19-79) years were evaluated. Thirty-seven malignant lymph nodes (23 metastatic and 14 lymphoma), seven malignant parotid tumors, two malignant submandibular tumors, 29 benign lymph nodes, 28 benign parotid lesions, and six benign submandibular lesions were evaluated. Mean SR and ES values of malignant masses were 6.3/3.2 for lymph nodes, 5.5/3.3 for the parotid gland, and 4.2/3 for the submandibular gland. Mean SR and ES values of benign lesions were 2.0/2.1 for lymph nodes, 4.4/3.2 for the parotid gland, and 3.2/3 for the submandibular gland. SR and ES were significantly higher for malignant masses compared with those for benign ones. SR was more predictive than ES in evaluating malignant lymph nodes. The area under the curve was 0.917(0.827-1.00) (p<0.05) for SR in differentiating benign-malignant lymph nodes, and the upper cut-off value was two. SR and ES were higher in the malign parotid and submandibular gland lesions than the benign ones, but the difference was not statistically significant. CONCLUSION: Strain ratio value could be a useful parameter in differentiating benign-malignant lymph nodes. More studies are necessary for differentiating benign-malignant parotid and submandibular lesions using SE.

The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women.

PURPOSE: To determine the frequency of pelvic varicose veins with transvaginal ultrasound and associated lower extremity venous insufficiency with Doppler ultrasound in women with chronic pelvic pain of undetermined origin. MATERIALS AND METHODS: A total of 100 women with chronic pelvic pain of undetermined origin lasting more than 6 months were included in the study. The presence of anechogenic and non-pulsatile vascular structures demonstrating flow in Doppler ultrasound with a diameter > 5 mm in parauterine and paraovarian localizations was accepted as pelvic varicose veins. In all patients, lower extremity venous systems were examined with Doppler ultrasound to assess possible associated venous insufficiency. Chi-square test was used for statistical analysis. RESULTS: Pelvic varicose veins were discovered with transvaginal ultrasound in 30 of 100 patients. This association was shown to be statistically significant. Various degrees of associated lower extremity venous insufficiency were also discovered in 21 of these 30 patients. CONCLUSION: This study has shown that the presence of pelvic varicose veins in women with chronic pelvic pain is not infrequent, and in the majority of cases, they are associated with lower extremity venous insufficiency. Since the diagnosis of lower extremity venous insufficiency plays an important part in deciding the course of treatment, lower extremity Doppler ultrasound must be included in the evaluation when pelvic varicose veins are discovered.