The goiter prevalence and urinary iodine levels among adolescents.

Endemic goiter and iodine deficiency are among the worldwide major public health problems of today. We aimed to research the goiter prevalence and the urinary iodine level of school children. In this descriptive study, 1,847 school children in Konya aged between 10 and 18 years were included. Urinary iodine level was measured. The mean value of iodine excretion in urine was 198 +/- 46.61 microg/L. In 40 students (2.2%), the urinary iodine level was < 100 microg/L. Six of these students (0.3%) had moderate iodine deficiency. Thyroid hyperplasia was found with palpation method in 128 students (6.9%). Ultrasonographically, five female students had solid nodule, and one male student had multiple nodules. In our study, no severe iodine deficiency was found. According to the results of our study, the mandatory iodization program in Konya has been conducted successfully.

Severe anaphylactic reaction to human insulin in a diabetic patient.

A 46-year-old nonatopic woman who had been suffering from type 2 diabetes for 17 years was hospitalized at the Endocrinology Department of Selcuk University due to very high glucose levels after recovery from acute hepatitis A infection. She had never used insulin before. After first subcutaneous dose of human regular insulin, severe local allergic reaction developed. Desensitization to insulin was tried. One day later, ketoacidosis developed. Human regular insulin was again subcutaneously injected to the patient. Severe anaphylactic reaction occurred, and in spite of all the medical attempts to save the patient, she died.

Lactate contents from cerebrospinal fluid in experimental subarachnoid hemorrhage, well correlate with vasospasm: ongoing and neurologic status.

The role of lactate composition of cerebrospinal fluid (CSF) with vasospasm severity and rabbit neurologic status in subarachnoid hemorrhage was determined. The neurologic status of 20 New Zealand rabbits were graded initially and then, anesthetized and basal angiograms were performed. Then 1.0 mL of CSF was withdrawn through cisterna magna and then 1 mL autologous arterial blood was injected in all rabbits over 1 minute. After 5 days, neurologic severity score (NSS) and vertebrobasilar angiograms of all rabbits were repeated. Rabbits without radiologic vasospasm or spasm under 50% (n=7) were termed as group 1. Rabbits whose cerebral vasospasm were 50% or over 50% (n=7) and NSS is lesser than 3 were termed as groups 2, and rabbits whose cerebral vasospasm were 50% or above 50% (n=7) and NSS is greater than 3 were termed groups 3. On day 7, the CSF lactate values of each group were significantly different (P<0.05) with each other. But when compared with only CSF baseline lactate values groups 2 and 3 were significantly different (P<0.05). However, the NSSs were similar in groups 1 and 2, but group 3 significantly differed from groups 1 and 2 (P<0.05). All groups significantly differed from baseline NSSs (P<0.05). The data showed clearly that the degree of vasospasm correlates not only with neurologic status but also with CSF lactate levels. We suggest that CSF lactate level may be useful as a surrogate marker of cerebral vasospasm degree after subarachnoid hemorrhage in clinics where invasive cerebral angiography could not be assessed for whatever reasons.

Three-dimensional MR and axial CT colonography versus conventional colonoscopy for detection of colon pathologies.

AIM: To evaluate the sensitivity and specificity of MR colonography (MRC) and CT performance in detecting colon lesions, and to compare their sensitivity and specificity with that of conventional colonoscopy. METHODS: Forty-two patients suspected of having colonic lesions, because of rectal bleeding, positive fecal occult blood test results or altered bowel habits, underwent the examinations. After insertion of a rectal tube, the colon was filled with 1000-1500 mL of a mixture of 9 g/L NaCl solution, 15-20 mL of 0.5 mmol/L gadopentetate dimeglumine and 100 mL of iodinized contrast material. Once colonic distension was achieved, three-dimensional gradient-echo (3D-GRE) sequences for MR colonography and complementary MR images were taken in all cases. Immediately after MR colonography, abdominal CT images were taken by spiral CT in the axial and supine position. Then all patients were examined by conventional colonoscopy (CC). RESULTS: The sensitivity and specificity of MRC for colon pathologies were 96.4% and 100%, respectively. The percentage of correct diagnosis by MRC was 97.6%. The sensitivity and specificity of CT for colon pathologies were 92.8%, 100%, respectively. The percentage of correct diagnosis by CT was 95.2%. CONCLUSION: In detecting colon lesions, MRC achieved a diagnostic accuracy similar to CC. However, MRC is minimally invasive, with no need for sedation or analgesics during investigation. There is a lower percentage of perforation risk, and all colon segments can be evaluated due to multi-sectional imaging availability; intramural, extra-intestinal components of colonic lesions, metastasis and any additional lesions can be evaluated easily. MRC and CT colonography are new radiological techniques that promise to be highly sensitive in the detection of colorectal mass and inflammatory bowel lesions.

Mangafodipir trisodium-enhanced magnetic resonance imaging for evaluation of pancreatic mass and mass-like lesions.

AIM: To investigate the role of mangafodipir trisodium (MnDPDP) in focal pancreatic masses and mass-like lesions by evaluating contrast uptake features of the lesions and pancreatic parenchyma after contrast medium injection. METHODS: A total of 37 patients with pancreatic mass or mass-like lesions were examined by unenhanced and MnDPDP-enhanced magnetic resonance imaging (MRI). RESULTS: MRI was obtained 20-40 min after infusion of MnDPDP and homogeneous contrast enhancement was observed in normal pancreas parenchyma. In patients with atrophic pancreas there was no enhancement in pancreatic parenchyma on MnDPDP-enhanced MRI. In 37 patients with 41 pancreatic masses and mass-like lesions, contrast enhancement was observed at 5 lesions on MnDPDP enhanced MRI. Three of these 5 lesions were focal pancreatitis and the other 2 were adenocarcinoma. No contrast enhancement was determined in 36 pancreatic masses and mass-like lesions in 32 patients. CONCLUSION: MnDPDP contrast-enhanced MRI, especially in cases with no parenchyma atrophy, can distinguish focal pancreatic lesion margins. Information about the function of pancreatic parenchyma can be obtained out of tumor. MnDPDP facilitates staging of pancreatic tumors by detection of metastatic lesions in the liver. In addition, diminished heteregenous uptake of MnDPDP in patients with pancreatitis may be helpful in differential diagnosis.

Characterization of focal liver lesions: use of mangafodipir trisodium (MnDPDP)-enhanced MR images.

BACKGROUND/AIMS: We evaluated the characterization and detection of liver lesions using mangafodipir trisodium. METHODS: A total of 51 patients with liver lesions [13 hepatocellular carcinomas, 18 metastases, 14 hemangiomas, three cholangiocellular carcinomas, two hydatic cysts, and one focal nodular hyperplasia (FNH)] were examined by unenhanced and mangafodipir trisodium-enhanced MRI. RESULTS: After administration of mangafodipir trisodium by slow intravenous infusion, mangafodipir trisodium-enhanced MRI was performed at 15-30 min and 24 h. The enhancement appeared in normal liver parenchyma and all of the hepatocellular lesions (HCCs and FNH). The lesions in hepatocellular carcinomas patients showed a non-homogeneous enhancement pattern. Non-hepatocellular lesions (hemangiomas, metastases, CCCs) had no enhancement on mangafodipir trisodium-enhanced MRI examinations. The rim-like enhancement pattern was demonstrated in all patients with cholangiocellular carcinomas, and in 14 metastases and 11 hemangiomas. CONCLUSIONS: Mangafodipir trisodium-enhanced MRI permits reliable distinction between hepatocellular and non-hepatocellular tumors. Mangafodipir trisodium-enhanced MRI can show more functional and morphologic features of hepatocellular lesions. Some non-hepatocellular lesions which went undetected on unenhanced MRI were visualized after contrast enhancement of the liver. The rim-like enhancement pattern is not specific for metastases. Mangafodipir trisodium-enhanced MRI is safe and well tolerated and may aid in noninvasive diagnosis of liver lesions.

Detection of colonic masses with MR colonography.

BACKGROUND/AIMS: Magnetic resonance colonography based on magnetic resonance imaging is a relatively new diagnostic modality for diagnosing colon pathology. The aim of this study was to evaluate its performance in detecting colorectal masses. METHODS: Thirty-three patients (20 male, 13 female; age range 28-85 years; mean age 78.7) suspected of having colonic lesions because of rectal bleeding, positive fecal occult blood test results or altered bowel habits underwent magnetic resonance colonography and subsequent conventional colonoscopy. All patients underwent standard bowel preparation 24 h before magnetic resonance colonography. Patients were placed in a supine position on the magnetic resonance table. After placement of a rectal tube, the colon was filled with of a mixture of 1000-1800 ml 0.9% NaCl solution and 15-20 ml 0.5 mmol/L gadopentetate dimeglumine solution. Once colonic distension was achieved, 3D GRE magnetic resonance colonography and complementary Magnetic resonance images were taken in all cases. RESULTS: Sensitivity of magnetic resonance colonography for colorectal masses was 90% and specificity was 100%. Percentage of correct diagnosis of magnetic resonance colonography was 94.3%. Magnetic resonance colonography was well tolerated without sedation or analgesia. CONCLUSIONS: Magnetic resonance colonography is a new technique for imaging of the colon. Magnetic resonance colonography has potential advantages of multiplanar capabilities and of being a less-invasive imaging technique; it can be implemented in daily practice and has a role in accurately staging colorectal cancers. In symptomatic patients, this new technique shows promising results for the detection and imaging of colorectal masses.

Spontaneous rupture of choledochal cyst presenting in childhood.

Spontaneous rupture of choledochal cysts is one of the rare complications, and can sometimes be the initial manifestation. It should be considered in the presence of bile-like fluid. A 10-year-old girl had acute onset of abdominal pain, vomiting, and elevated bilirubin, alkaline phosphatase, glutamic oxaloacetic transaminase and glutamic-pyruvic transaminase levels. There was no trauma in her history. In ultrasonography and computed tomography, dilated common bile duct, cystic mass of 10 x 6 cm, and free intraperitoneal fluid in abdominal cavity were demonstrated. Radiological methods, especially intraoperative cholangiography, should be performed for evaluation. We report a case of spontaneous rupture of the choledochal cyst with clinical and radiological findings.

Mesenteric ischemia: an unusual presentation of fistula between superior mesenteric artery and common hepatic artery.

Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.

Diagnostic value of diuretic-enhanced excretory MR urography in patients with obstructive uropathy.

PURPOSE: Ultrasonography and conventional intravenous urography are most common methods in diagnosis of obstructive uropathies. The disadvantage of ultrasonography is inability of visualizing middle and lower one thirds of ureter, while intravenous urography is using radiation, also functionally extra loading effect on kidneys. In this study, the diagnostic value of MR urography on obstructive uropathy were investigated. MATERIALS AND METHODS: Forty five patients who were suffered from obstructive uropathy examined by ultrasonography, intravenous urography and diuretic-enhanced excretory MR urography by using MR-contrast-agent. RESULTS: MR urography established accuracy rate of 92.8% for stone diseases which formed the largest group in this study, however, in other causes of obstructive uropathy, MR urography provide 100% correct diagnosis. CONCLUSION: MR urography provide high quality images for diagnosing and determining causes of urinary obstruction defining position and severity of dilatations as well as showing localization of the pathology. We think that MR urography should be a primary investigation in patients with obstructive uropathy who have contrast agent and X-ray contrindication.

Linburg-Comstock anomaly in musicians.

Anomalous tendon connections from the flexor pollicis longus to the index finger flexor digitorum profundus cause lack of independent excursion of the flexor pollicis longus, first described in 1979 by Linburg-Comstock. This anatomical variation is potentially problematic for musicians. The purpose of this study was to evaluate the incidence of this anomaly in musicians and to operate on the symptomatic patients with a limited incision with the help of magnetic resonance imaging. We studied the incidence of the anomaly among 136 musician volunteers. A lower incidence rate of the anomaly was determined in this study. One of the symptomatic musicians was operated on and the tendinous connection was excised. Clinical examination of 136 volunteers suggested that the anomaly was present in 13% of the volunteers; unilateral in 9% and bilateral in 4%. Follow-up of the patient who was operated on revealed full pain-free function without any complaint. Surgical treatment although rarely necessary, is simple and effective.

Bilateral common carotid occlusion without neurological deficit.

A 40-year-old man presented with pain and numbness in his right arm. On his clinical examination, no neurological deficit was found. Bilateral common carotid artery duplex sonography scan demonstrated no flow in either lumen. No abnormality was recognized on brain CT. On cerebral digital substraction angiogram, total occlusion of the brachiocephalic trunk and left carotid artery were shown. There was a modest stenosis in the left vertebral artery. Collateral circulation feeding the intracranial carotid system mainly originated from the left vertebrobasilar system. Previous cases of bilateral carotid occlusion are reviewed and discussed.

Post-traumatic arteriovenous fistula presented with hypertrophic palmaris digitalis II.

A 19-year-old female was admitted to our department because of a hypertrophic palmaris digitalis II of the left hand displaying color changes. A thrill was easily palpated over the medial part of the finger. A review of her history revealed that this hypertrophy occurred after a blunt trauma to the left hand. Angiography showed arteriovenous fistulas between the digital branches of the radial and ulnar arteries and cephalic vein at the palmaris digitalis II of the left hand. These arteriovenous connections were closed with simple ligation under regional anesthesia. Post-operatively she had no sign of ischemia, and no thrill was palpated or auscultated.

Contrast media-enhanced power Doppler sonography for evaluation of hemangiomas and malignant tumors in the liver.

AIM: To evaluate the characterization of liver hemangiomas and malignant tumors using power Doppler sonography before and after intravenous injection of a sonocontrast agent. METHODS: Forty-five patients with 57 liver tumors (22 hemangiomas, 24 metastases, 10 hepatocellular carcinomas (HCC) and one cholangiocellular carcinoma) were examined prospectively. The distribution (peripheral, central, mosaic) and extent (none, minimal, moderate and strong) of intratumoral flow pattern in each sonographic examination was subjectively classified. RESULTS: The administration of the sonocontrast agent by bolus injection caused enhancement to gradually increase up to 2 min and lasted for 4-5 min. After injection of contrast agent, flow signals appeared or increased in 34 tumors. No signal enhancement was observed in 18 hemangiomas, four metastases and one HCC. The sensitivity and specificity of intratumoral vascularity for the detection of malignant liver tumors was 37.1 and 90.9% for unenhanced power Doppler sonography, and 85.7 and 81.8% for contrast-enhanced power Doppler sonography, respectively. CONCLUSION: Contrast-enhanced power Doppler sonography is superior to unenhanced power Doppler sonography in the demonstration of malignant tumor vascularity, and is helpful in differentiating between hemangiomas and malignant liver tumors. A specific flow pattern within the tumor is not established in primary and metastatic malignant tumors with contrast-enhanced power Doppler sonography.

[Plexiform neurofibroma in the gingiva]. / Gingivada pleksiform nörofibroma.

Neurofibromatosis type 1 is the most common autosomal dominant disorder of the nerve sheath and best defined phakomatosis. It usually affects skeletal system, central nervous system, eye, endocrine gland and cardiovascular system. Gingival involvement is very rare. We report radiological findings of three patients with plexiform neurofibroma who had diffuse, unilateral gingival involvement.