Quantitative brain diffusion-tensor MRI findings in patients with sickle cell disease.

OBJECTIVE: The aim of this study was to evaluate the microstructure of various regions of the brain using diffusion-tensor imaging (DTI) in patients with sickle cell disease (SCD) and in age- and sex-matched healthy control subjects. We also investigated the fiber tractography findings of the corpus callosum (CC) and corticospinal tracts (CSTs). SUBJECTS AND METHODS: Sixteen right-handed patients with SCD and 14 age- and sex-matched right-handed healthy control subjects were scanned using conventional MR sequences and DTI. Fractional anisotropy (FA) and apparent diffusion coefficients (ADCs) were calculated and regions of interest were selected in various brain areas (superior and inferior frontal, parietal, occipital, and temporal white matter areas), anterior and posterior periventricular areas, centrum semiovale, basal ganglia (lentiform nucleus, head of caudate nucleus), thalamus, cerebral peduncles, pons, cerebellar white matter areas, and CC. Diffusion-tensor tractography of the CC and CSTs was also performed. RESULTS: For the patients with SCD, significantly reduced FA values, increased ADC values, or both were seen clustered in several brain areas, including the CC, frontal white matter, centrum semiovale, periventricular areas, head of the caudate nucleus, thalamus, brainstem, and pons (p < 0.05). Statistically significant reductions in fiber counts in the first and fifth segments of the CC and in CSTs bilaterally were also observed in patients with SCD (p < 0.05). CONCLUSION: DTI shows microstructural abnormalities of various brain areas in patients with SCD.

Increased amount of visceral fat in patients with psoriasis contributes to metabolic syndrome.

BACKGROUND: Psoriasis is associated with obesity and metabolic syndrome. Metabolic syndrome is associated with visceral fat accumulation. There is no study on the accumulation of visceral fat in patients with psoriasis. OBJECTIVE: The aim of this study was to compare the visceral fat accumulation in patients with psoriasis and controls. SUBJECTS AND METHODS: 46 patients with psoriasis and 46 sex- and age-matched control patients were included in this study. The abdominal fat area [visceral fat area (VFA), subcutaneous fat area (SFA) and total fat area (TFA)] at the level of the umbilicus was evaluated by computed tomography. RESULTS: The mean VFA value and VFA/SFA ratio of the psoriasis patients were significantly higher compared with the control patients (123.4 +/- 80.3 vs. 81.2 +/- 59.8 cm(2) and 0.734 +/- 0.593 vs. 0.491 +/- 0.336; p = 0.005 and p = 0.017, respectively). Fasting blood sugar levels were also found to be significantly higher in psoriasis patients, compared with the control patients (101.8 +/- 43.5 vs. 83.4 +/- 9.1 mg/dl; p = 0.005). Multiple linear regression analysis indicated that waist-to-hip ratio, age, body weight, the presence of psoriasis and metabolic syndrome were significantly associated with VFA. CONCLUSION: Psoriasis patients had a higher amount of VFA, compared with the control patients.

Twin pregnancy with a complete hydatidiform mole and co-existent live fetus: two case reports and review of the literature.

INTRODUCTION: The aim of this study was to report the clinical features, management, and outcome of two cases of complete hydatidiform mole with a coexisting viable fetus and to review the literature. CASE REPORTS: In this article, we report on the well-documented follow-up of two cases of twin pregnancies with complete hydatidiform mole and a normal fetus. Genetic amniocentesis showed normal fetal karyotype in both of two cases. In the first case, a live male infant was delivered by a cesarean section because of severe maternal bleeding at 29 weeks of gestation. In the second case, termination of pregnancy was performed due to early onset of severe preeclampsia and vaginal hemorrhage. CONCLUSION: The chances of a live birth have been estimated between 30 and 35% and the risk of persistent trophoblastic disease is similar to singleton molar pregnancies in complete mole with coexisting fetus pregnancy. Therefore, in these pregnancies, expectant management instead of termination of pregnancy can be suggested.

[The evaluation of early pulmonary involvement with high resolution computerized tomography in asymptomatic and non-smoker patients with rheumatoid arthritis]. / Semptomsuz ve sigara içmeyen romatoid artritli hastalarda erken dönem akciger tutulumunun yüksek rezolüsyonlu bilgisayarli tomografi ile degerlendirilmesi.

To investigate pulmonary involvement by high resolution computerized tomography (HRCT) in patients with rheumatoid arthritis (RA) who are asymptomatic and lifelong non-smoker. Twenty-five patients with RA who are asymptomatic and lifelong non-smoker were included in the study. After clinical and laboratory investigations, plain chest X-rays, pulmonary function tests (PFT) and HRCT were performed. End expiratory HRCT slices were obtained for air trapping. Chest X-ray, PFT and HRCT findings showed 12%, 16%, 48% abnormalities, respectively. Interstitial involvement was the most common finding on HRCT (36%) and followed by air trapping (20%). Bronchiectasis, pulmonary nodule, and pleural disease were seen in 16%, 12%, and 12% of patients, respectively. None of patients had emphysema and honeycomb pattern. There was no statistically significant correlation between HRCT findings and disease activity criteria, RF positivity, PFT results and duration of the disease. Our study shows that pulmonary involvement is not always together with respiratory symptoms and impaired pulmonary function in patients with RA. New studies are needed which investigating the effects of radiologically detected lung involvement on prediction of survival and treatment choice in asymptomatic and nonsmoker RA patients.

The prevalence and significance of incidental middle ear and mastoid cavity abnormalities on MRI in a pediatric population.

OBJECTIVE: The purposes of this study were to determine the prevalence of abnormalities in the middle ear and mastoid cavity on the magnetic resonance imaging (MRI) in children and correlate the results with clinical data, tympanometric findings and paranasal sinus changes. MATERIALS AND METHODS: A total of 85 consecutive pediatric patients for suspected non-inflammatory intracranial pathologies were prospectively examined. MRI was conducted for the suspected intracranial pathology. All patients were also examined by an otolaryngologist for otologic pathologies. A tympanometry examination was performed in patients prior to MRI scan. RESULTS: In 23 (27.1%) of 85 (39 males, 46 females) children, MRI demonstrated middle ear and/or mastoid cavity abnormalities. MRI abnormalities of the middle ear and/or mastoid cavity were correlated with clinical data and tympanometric findings. CONCLUSIONS: Incidental abnormal signal intensities in the middle ear and/or mastoid cavity are frequent in children, especially in first years of life. MRI will demonstrate incidental middle ear and mastoid cavity abnormalities seems to have clinical significance.

Thyroid Doppler indices in patients with sickle cell disease.

OBJECTIVE: To evaluate the intrathyroidal hemodynamic changes and thyroidal volume in sickle cell disease (SCD) patients. METHODS: Thirty-two patients with homozygous SCD and 32 control subjects were examined with color Doppler ultrasonography. None of the patients and control subjects had clinical or laboratory evidence of thyroid disease. RESULTS: SCD patients had significantly higher resistance index (RI) and pulsatility index (PI) values and lower thyroid volume compared with control group. CONCLUSION: Increased intrathyroidal RI and PI and decreased thyroid volume may be due to impaired thyroidal microcirculation. Further and follow-up studies are needed to explain the relationship between Doppler parameters and thyroid functions.

Dermatofibrosarcoma protuberans: A case report of a rare, bulky tumor that was managed with surgical therapy.

We report a case of this rare tumor and describe the surgical approach that we adopted and the clinical outcome; we also report his condition at 24 months' follow-up. Although treatment was with radical surgery, sufficient shoulder function could be obtained in our patient. We also describe the interesting MR findings of this tumor which correlated well with the histopathologic findings.

Effects of diffuse fatty infiltration of the liver on portal vein flow hemodynamics.

PURPOSE: To investigate the effects of various degrees of diffuse fatty infiltration of the liver on portal vein blood flow with Doppler sonography. METHODS: One hundred forty subjects were examined with color and spectral Doppler sonography. The subjects were divided into 4 groups of 35 subjects each according to the degree (normal, grade 1, grade 2 and grade 3) of hepatic fatty infiltration assessed on gray-scale images. The portal vein pulsatility index (VPI) and time-averaged mean flow velocity (MFV) were calculated for each subject. VPI was calculated as (peak maximum velocity - peak minimum velocity) / peak maximum velocity. RESULTS: VPI and MFV values were, respectively, 0.32 +/- 0.06 and 16.8 +/- 2.6 cm/second in the normal group, 0.27 +/- 0.07 and 14.2 +/- 2.2 cm/second in the group with grade 1 fatty infiltration, 0.22 +/- 0.06 and 12.2 +/- 1.8 cm/second in the group with grade 2 fatty infiltration, and 0.18 +/- 0.04 and 10.8 +/- 1.5 cm/second in the group with grade 3 fatty infiltration. There was a negative inverse correlation between the grade of fatty infiltration and both VPI (f = 55.3, p < 0.001) and MFV (f = 43.9, p < 0.001). CONCLUSION: The pulsatility index and mean velocity of the portal vein blood flow decrease as the severity of fatty infiltration increases.

Long-term effect of varicocele repair on intratesticular arterial resistance index.

PURPOSE: To investigate the long-term effect of varicocele repair on ipsilateral intratesticular arterial resistance index (RI) using color Doppler sonography (CDS). METHODS: A total of 26 infertile patients with left varicocele who underwent a testicular artery and lymphatic-sparing subinguinal varicocelectomy were examined with CDS for intratesticular flow parameters before and at least 6 months after surgery. We also evaluated preoperative and postoperative semen parameters. RESULTS: The mean values of RI, end-diastolic velocity and pulsatility index decreased significantly after surgery, whereas no significant change was observed in peak systolic velocity. Repair of the varicocele resulted in a statistically significant increase in the total sperm count, motility, morphology, and total motile sperm count. However, no significant correlation was found between sperm parameters and RI values (p > 0.05). CONCLUSIONS: Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after surgical varicocele repair, without significant correlation between these 2 changes.

Prevalence of abdominal ultrasonographic abnormalities in patients with sickle cell disease.

PURPOSE: The aim of this study was to evaluate the type and prevalence of abdominal ultrasonographic abnormalities in patients with sickle cell disease. MATERIALS AND METHODS: A total of 102 patients with sickle cell disease at the Center of Hemoglobinopathy of the Antakya State Hospital were screened for intra-abdominal abnormalities by abdominal ultrasonography (US). Eightyfour patients were homozygous for sickle-cell disease (S/S), and 18 patients were compound heterozygotes for sickle cell-Beta thalassemia (S/Beta(thal)). At the time of examination, 15.7% (16/102) of patients had undergone splenectomy, and 18.6% (19/102) of patients had undergone cholecystectomy. RESULTS: The most frequent US findings (expressed as percentages of all patients) were hepatomegaly (71.6%), renal enlargement (30.4%), autosplenectomy (33.3%), cholelithiasis (30.4%) and splenomegaly (17.4%). A bright liver was identified in 6 patients (5.9%), an echogenic pancreas in 4 patients (3.9%), and pancreatic punctate echogenic foci were identified in 5 patients (4.9%). Medullary or diffusely increased renal echogenicity was observed in 16 patients (15.7%). Sonographic findings typical of renal papillary necrosis were observed in one patient with S/S. Periportal lymphadenopathy was detected in 10 (11.9%) of 84 patients of the S/S group, and 2 (11.1%) of 18 patients of S/Beta(thal) group. CONCLUSION: Abdominal ultrasonographic imaging of patients with sickle cell disease revealed a high prevalence of abdominal abnormalities, especially in solid organs.

CT assessment of main pulmonary artery diameter.

PURPOSE: The purpose of this study was to determine the normal range of the main pulmonary artery diameter (MPAD) by computed tomography (CT) in persons with normal pulmonary artery pressure, and then to evaluate the relationship of the diameter with age, gender, and body surface area (BSA). MATERIALS AND METHODS: Between October 2005 and June 2007, among patients who had previously undergone a contrast-enhanced thorax CT scan, 112 persons (47 females, 65 males) without pulmonary pathology were selected for the study. All patients had normal mean pulmonary artery pressure. The widest diameter perpendicular to the long axis of the main pulmonary artery was measured at the pulmonary artery bifurcation level. The outer limits of the contrast were used to determine vessel diameter. RESULTS: Pulmonary artery diameters showed a homogeneous distribution; the CT-determined mean pulmonary artery diameter was 26.6 +/- 2.9 mm. The mean MPAD in males was 27 +/- 2.8 mm, and 25.9 +/- 3.0 mm in females. This difference was considered to be statistically significant (P = 0.048). There was a significant relationship between the MAPD and age and BSA (P = 0.043, P < 0.001). CONCLUSION: The present study demonstrated that in individuals with normal pulmonary artery pressure, the upper limit of the MPAD is 32.6 mm and that MPAD is wellcorrelated with BSA.