Carotid Arterial Flow in Pseudoexfoliation Glaucoma and its Role in Diagnosing the Disease.

OBJECTIVE OF THE STUDY: The objective of the study was to investigate the change in carotid arterial flow in pseudoexfoliation glaucoma (XFG) for determining its diagnostic value. MATERIALS AND METHODS: Patients with XFG (N=30) and control subjects (N=22) were recruited. Common carotid artery (CCA) and internal carotid artery of each participant were examined using color Doppler and B-mode ultrasonography. Resistivity index (RI), as a flow parameter of interest, was measured and statistically compared between the 2 groups. Receiver operating characteristic was also produced to assess its diagnostic value. RESULTS: The measured RI values from the controls were within the expected range. Among CCA and internal carotid artery, only RI of CCA exhibited statistically significant changes in XFG (0.75±0.04 vs. 0.70±0.03 cm/s). Threshold value of RI=0.72 yielded 90% sensitivity and 73% specificity in distinguishing the cases of XFG from the controls. CONCLUSIONS: Flow dynamics of carotid arterial system exhibits different characteristics in individuals with XFG than controls. Such differences may serve as a basis for developing potentially new diagnostic biomarkers of XFG. Further studies are justified for examining the carotid flow in pseudoexfoliation syndrome and compare it against XFG for determining its power in differential diagnosis.

Comparison between dynamic susceptibility contrast magnetic resonance imaging and arterial spin labeling techniques in distinguishing malignant from benign brain tumors.

OBJECTIVES: The purpose of this study was to preliminarily compare unenhanced arterial spin-labeled (ASL) imaging, dynamic susceptibility contrast-enhanced cerebral blood volume (DSCE-CBV) magnetic resonance imaging (MRI) for evaluation of tumor perfusion in patients with brain tumors. MATERIALS AND METHODS: A total of 27 patients with brain tumors were examined in 1,5T MRI. Single phase and multiphase ASL, DSCE-CBV examinations were assessed by both qualitative and quantitative analysis for the detection of malignancy. Imaging results were correlated with a histopathology or follow-up. RESULTS: Based on 31 studies in 27 patients with brain tumors, the visual inspection sensitivities for ASL and dynamic DSC perfusion imaging were 88% and 94%, respectively, with 100% specificity for both. On qualitative evaluation, sensitivities for ASL and DSC perfusion imaging perfusions were 88% and 94%, respectively, with 100% specificity for both. The highest sensitivity values for quantitative ASL imaging were obtained using a normalized cut-off ratio of 1.65, resulting in sensitivity of 94% for ASL imaging and cut-off ratio of 1.95 and sensitivity 94% for DSCE-CBV imaging. CONCLUSION: The present study revealed similar sensitivity and specificity for both multhiphase ASL and DSC MRI. Thus, we suggest that ASL perfusion can be used in daily clinical practice.

Ophthalmic artery blood flow parameters in pseudoexfoliation glaucoma.

PURPOSE: To investigate orbital flow parameters of ophthalmic artery (OA) in patients with pseudoexfoliation glaucoma (XFG) by ultrasonography. METHODS: This case-control study included 38 patients with XFG and 32 healthy control subjects. Color Doppler imaging was performed to evaluate orbital flow parameters of OA. Receiver operating characteristic analyses were performed to define the best cutoff value. RESULTS: In the XFG group, decreased peak systolic velocity (p = 0.114), end diastolic velocity (p = 0.002), and increased resistivity index (RI) (p<0.001) at OA compared to healthy controls were observed. A cutoff value 0.72 for OA RI was found to have a sensitivity of 66% and specificity of 94%. CONCLUSIONS: The results support the findings of increased vascular resistance in OA XFG. High sensitivity and specificity obtained for OA RI may be useful in evaluation of future therapeutic vascular agents.

[Research to investigate human cystic echinococcosis with ultrasound and serologic methods and educational studies in different provinces of Aydin/Turkey]. / Aydin Ilinin Farkli Bölgelerinde Ultrason ve Serolojik Yöntemlerle Kistik Ekinokokkoz Arastirilmasi ve Egitim Çalismalari

OBJECTIVE: Cystic echinococcosis (CE) is particularly prevalent in rural areas where domestic animal breeding is common. We planned to investigate the CE among the 7-88 years old inhabitants of (n=209) four villages in the Aydin district, by a portable ultrasound scanner (US) and with serologic methods. METHODS: Participants were assessed by ultrasound and sera samples were tested for anti-E. granulosus antibodies by serological tests (ELISA and IHA). A questionnaire was given to the participants in order to assess their knowledge about the disease. RESULTS: Hepatic CE was detected in one case (0.47%) by US, while 24 (11.48%) and 28 (13.39%) cases were found to be seropositive for CE by ELISA and IHA, respectively. With both tests, in 9 participants (4.3%), parasite-specific antibodies were detected. According to questionnaire results, 84.22% of the participants were found to have no knowledge about the disease. Only 15.21% of the dog owners were giving anti-parasite drugs to their dogs. CONCLUSION: This study is one of the small number of community-based studies about CE performed in Turkey, in which US was applied. Our results suggest that we need national control programs including a multi-sectorial collaboration to eradicate hydatidosis and effective actions to control cystic echinococcosis.

Successful treatment of early relapse of ocular myeloma with bortezomib and steroid after autologous stem cell transplantation.

Autologous stem cell transplantation (ASCT) can prolong remission duration, overall and progression free-survival in multiple myeloma (MM). Ocular relapse is rare in MM. Here we present a patient with only ocular relaps and without evidence of bone marrow progression after ASCT. Ig A kappa myeloma, stage IIIA was diagnosed in a 53-year-old man, according to Kyle-Greipp and Durie Salmon. He was treated with three courses of VAD therapy. Then he received high dose melphalan (200 mg/m2), followed by the ASCT. After two months from ASCT, he had bilateral blurry vision, pain, redness in both eyes and diplopia. We detected 5 mm of right-sided proptosis by Hertel exophthalmometry (base 110, 20 mm right eye, 15 mm left eye). Ocular motility of oculus dexter (OD) was restricted in up and lateral gaze. He has diplopia in up gaze. His color vision was 7 of 12 in the right eye and 10 of 12 in the left eye with Ishihara plates. Best corrected visual acuity was 6/10 in the right eye and 7/10 in the left eye. Intraocular pressures were 19 mmHg for OD and 18 mmHg for oculus sinister (OS). Slit lamp biomicroscopy revealed subconjunctival hemorrhages superiorly and temporally in the right eye and bilateral conjunctival hyperemia with chemosis. Fundus examinations of both eyes were unremarkable. Computed tomography and magnetic resonance imaging of orbita revealed a right intraorbital extraconal soft tissue density mass that involved the lacrimal gland and lateral rectus muscle. Prednisolon 1mg/kg/day and bortezomib 1.3 mg/m2 were started (1, 4, 8, 11 days). Eye findings were recovered after one month. Ocular relapse should be considered if there are ocular findings after ASCT for MM. Bortezomib and steroid may be useful for ocular extramedullary relapse of MM (Fig. 2, Ref. 8).

[Should cystic echinococcosis be investigated in patients having high eosinophil counts?]. / Eozinofil sayisi yüksek olanlarda kistik ekinokokkozis arastirilmali mi?

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is one of the important health problems in Turkey and in the world. In this study, whether or not the presence of CE in patients with a high eosinophil count should be determined was investigated. A total of 946 specimens from patients with a high eosinophil count (>or=350/mm3) were evaluated. The age of patients ranged from 1-94 years. Of the patients, 392 (41.4%) were male and 554 (58.6%), female. The specific antibody response in the specimens was determined by ELISA and IHA. Specific antibody response was detected in five sera of 946 (0.53%) patients with ELISA and IHA. The patients, with an antibody response, were evaluated further with liver ultrasonography and chest X-ray. One patient, in which an antibody response was detected, had a history of renal cell carcinoma surgery. In one patient (0.11%), CE was detected in the liver and the diagnosis was confirmed by surgery. No CE was found in the other three patients. In conclusion, eosinophilia is not a sufficient indicator for CE alone and this parasite should be sought in patients with clinical and radiological signs.

Hypoplastic inferior rectus muscle in association with accessory extraocular muscle and globe retraction.

Ocular motility problems related to congenital abnormalities of extraocular muscles are rare conditions. Such congenital abnormalities may present in a spectrum from accessory additional rectus muscles to absence of extraocular muscles. Absence of one or more extraocular muscles is a rare condition usually seen in association with craniofacial syndromes and only rarely in isolation. None of the cases with the absence of an extraocular muscle were reported to be in association with an accessory extraocular muscle or paradoxical contraction of an extraocular muscle. We present a case with bilateral hypoplasia of the inferior rectus muscle with an accessory extraocular muscle in association with globe retraction and lambda-pattern exodeviation.