Comparative Analysis of Percutaneous Excision and Radiofrequency Ablation for Osteoid Osteoma.

BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.

Pilot study of the diagnostic value of CRP:albumin ratio for osteomyelitis in patients with diabetic foot ulcers.

OBJECTIVE: Osteomyelitis may complicate diabetic foot ulcers (DFUs). As a new inflammation-based prognostic factor, CRP:albumin ratio's significance is not known in osteomyelitis among patients with or without diabetes. METHOD: Patients with type 2 diabetes and DFUs were divided into two groups: group 1 (n=47) comprised patients without osteomyelitis, and group 2 (n=50) comprised patients with osteomyelitis. RESULTS: Erythrocyte sedimentation rate (ESR) (88.5±23.0 versus 42.0±22.2), white blood cell count (WBC) (14.7±6.9x103 versus 10.0±4.4x103), C-reactive protein (CRP) level (15.6±9.9 versus 2.4±3.3) and CRP:albumin ratio (6.6±4.9 versus 0.7±1.0) were significantly higher, and albumin level was significantly lower in group 2 compared to group 1 (p<0.001 for all). The presence of osteomyelitis was significantly and positively correlated with ESR (r=0.721; p<0.001), WBC (r=0.380; p<0.001), CRP (r=0.667; p<0.001) and CRP:albumin ratio (r=0.638; p<0.001), and negatively correlated with albumin (r=-0.590; p<0.001). A CRP:albumin ratio of 1.74 or above could predict osteomyelitis with 92.0% sensitivity, 80.9% specificity, and the best area under the curve (AUC) score (AUC=0.957; 95% CI: 0.924-0.991). ESR (odds ratio (OR): 1.071 (1.025-1.119); p=0.02) and CRP:albumin ratio (OR: 2.65 (1.437-4.885); p=0.002) were independent predictors in the final model for stepwise linear regression analyses for the estimation of osteomyelitis. CONCLUSION: CRP:albumin ratio is a cheap and repeatable inflammatory marker and can successfully detect osteomyelitis in patients with DFU.

Central nervous system variations and abnormalities in anhidrotic ectodermal dysplasia (AED): neuroimaging findings.

BACKGROUND: Anhidrotic ectodermal dysplasia (AED) is a rare, mostly X-linked recessive genodermatosis, characterized by congenital defects of ectodermal derivative structures as the central nervous system (CNS) is primarily ectodermal in origin. PURPOSE: To evaluate CNS variations and abnormalities in AED. MATERIAL AND METHODS: A retrospective analysis was made of the neurological and neuroimaging findings of 17 children (12 boys, 5 girls; median age = 8 years; age range = 2-14 years) diagnosed with AED in our pediatric clinics during 2008-2016. The pattern of CNS variation and abnormalities were evaluated by comparing of these findings with an age- and gender-matched healthy control group with no family history. RESULTS: Of the 17 AED cases identified on the basis of neuroimaging findings, 6 (35.3%) were seen to be normal. Associated CNS variation and abnormalities including cavum septum pellucidum (35.3%), callosal dysgenesis (11.8%), prominent Virchow-Robin spaces (64.7%), cortical sulcal dilation (41.1%), mega cisterna magna (35.3%), focal cortical dysplasia (11.8%), and delayed myelination (58.8%) were observed in 11 (64.7%) children with AED. CONCLUSION: AED suggests a spectrum of CNS variation and abnormalities, presenting with neurological and neuroimaging findings, demonstrated in the embryonic surface- and neuro-ectoderm derived structures. The results of this study suggest that CNS variation and abnormalities might be associated with AED.

A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma.

PURPOSE: The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma. MATERIALS AND METHODS: Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted. RESULTS: The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups. CONCLUSION: Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.

Investigation of the retrorenal colon frequency using computed tomography in patients with advanced scoliosis.

PURPOSE: The aim of this study is to investigate the frequency of retrorenal colon in patients with advanced scoliosis. MATERIALS AND METHODS: The existence of retrorenal colon was retrospectively investigated in 550 patients with vertebral scoliosis who had undergone abdominal CT scans at our institution between January 2008 and March 2012. The investigation was also carried out on a control group of 200 patients without scoliosis. RESULTS: Among the 550 patients with scoliosis, 100 patients had advanced scoliosis necessitating treatment. Among these 100 patients with advanced scoliosis, retrorenal colon was detected in a total of 25 patients (25 %). The variation was observed on the right side in eight patients (two males, six females) (8 %), on the left side in 15 patients (five males, ten females) (15 %), and bilaterally in two patients (both females) (2 %). In the control group consisting of 200 individuals, retrorenal colon was detected in seven subjects (3.5 %), among which six were on the left and one was on the right. The difference between the incidence of retrorenal colon observed in the patients with advanced scoliosis and those without scoliosis was found to be statistically significant (p < 0.001). CONCLUSION: Since the frequency of retrorenal colon in patients with advanced scoliosis is significantly higher than the control group without scoliosis, the risk of experiencing complications during renal interventions including renal biopsy is also higher. Therefore, these patients should undergo a detailed CT examination before these procedures, and renal interventions should be planned according to findings.

Expression of GRP78 and its copartners in HEK293 and pancreatic cancer cell lines (BxPC-3/PANC-1) exposed to MRI and CT contrast agents.

Endoplasmic reticulum (ER) stress-associated chaperones trigger a defense mechanism called as unfolded protein response (UPR) which can manage apoptosis and be determinative in cell fate. Both anticancer drug effects and potential toxicity effects of magnetic resonance imaging (MRI) and computed tomography (CT) contrast agents were aimed to be evaluated. For this purpose, we investigated expression profiles of endoplasmic reticulum stress-associated chaperone molecules in human pancreatic tumor lines BxPC-3 and PANC-1 and control human embryonic kidney cells 293 (HEK293) induced with a variety of gadolinium and iohexol contrast agents. Protein expression levels of ER stress-associated chaperones (master regulator: GRP78/Bip and its copartners: Calnexin, Ero1, PDI, CHOP, IRE1α and PERK) were evaluated with Western blotting. Expression levels at mRNA level were also assessed for GRP78/Bip and CHOP with real-time PCR. Induction of cells was carried out with four different Gd-based contrast agents (GBCAs): (Dotarem, Optimark, Primovist and Gadovist) and two different iohexol agents (Omnipol, Omnipaque). CT contrast agents tested in the study did not result in significant ER stress in HEK293 cells. However, they do not seem to have theranostic potential in pancreas cancer through ER pathway. The potential efficiency of macrocyclic MRI contrast agents to provoke apoptosis via ER stress-associated chaperones in BxPC-3 cells lends credibility for their future theranostic use in pancreas cancer as long as undesired toxicity effects were carefully considered. ER stress markers and/or contrast agents seem to have promising potential to be translated into the clinical practice to manage pancreas cancer progression.

Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: is it a predisposing factor for rupture risk?

BACKGROUND: A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture. MATERIAL/METHODS: The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant. RESULTS: General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs. CONCLUSIONS: Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space.

Bullet trajectory detection in the lung: Multiplanar reformatted imaging of multidetector computed tomography in children.

BACKGROUND: Trauma is a leading cause of childhood injuries. Although blunt traumas in children are more common in penetrating traumas, children in civilian life and near conflict areas can often be affected by gunshot wounds. Among all gunshot wounds, thoracic injuries constitute a significant proportion. In our study, we detected bullet trajectory in children with gunshot wounds penetrating the thorax by analyzing reformatted images of multidetector computed tomography (CT). METHODS: Nineteen pediatric patients with thoracic gunshot wounds were evaluated retrospectively. After all patients admitted the emergency service, their hemodynamics were stabilized first. Then, PA-AC radiography and thorax CT were taken and necessary imaging studies of other body parts were performed. CT scans were performed with multi-detector CT. RESULTS: Using reformatted axial, sagittal, and coronal and oblique images of multidetector CT, we detected projectile trajectory in the lung parenchyma in 74% of patients. In 26% of the patients, the projectile trajectory could not be detected due to excessive parenchymal hemorrhage, hemothorax, and pneumothorax. CONCLUSION: In our study, a standard could not be made due to the fact that the types of weapons used could not be determined, the firing distances could not be known, different ages and different bullet entry and exit angles. However, detecting the trajectory of the bullet in the lungs will assist the physician in making the treatment plan and following up the patient. In addition, the evaluation of the data obtained will be beneficial to forensic medicine physicians and scientists interested in wound ballistics.

Evaluation of the anterior shoulder instability using ultrasound shear wave elastography.

OBJECTIVES: This study aims to evaluate the soft tissue stiffness which has a prominent role in shoulder instability using ultrasound (US) shear wave elastography (SWE) and to compare the results with healthy shoulders. PATIENTS AND METHODS: Between December 2018 and January 2020, a total of 33 male patients (mean age: 26±4.3 years; range, 18 to 35 years) who underwent arthroscopic repair for traumatic isolated anterior glenohumeral instability were included in this prospective study. The shoulder girdle was evaluated with US SWE in patients with traumatic anterior instability. Deltoid (D), supraspinatus (SS), infraspinatus (IS), subscapularis (SSC), and long head of biceps (LHB) tendons forming the shoulder girdle and anterior labrum (L) were evaluated with SWE. The elasticity and velocity of the tissues were quantitatively measured. The operated shoulders of 33 patients due to isolated traumatic anterior instability were named Group 1, while the healthy shoulders of these patients were named Group 2. Thirty volunteers with healthy shoulders were considered as the control group (Group 3, n=30). RESULTS: All three groups were compared in terms of SS, D, LHB, and SSC tendon velocity and elasticity; however, no statistically significant difference was observed among the groups (p<0.05). The anterior labrum of these three groups did not significantly differ in terms of SWE measurements (p<0.05). CONCLUSION: The stiffness of shoulder girdle muscle tendons and labrum measured with US SWE does not constitute a risk factor for traumatic anterior shoulder instability.

Magnetic resonance spectroscopy findings of pyogenic, tuberculous, and Cryptococcus intracranial abscesses.

Proton magnetic resonance spectroscopy (MRS) complements conventional methods used to differentiate intracranial cystic lesions. We report MRS findings of three cases that were diagnosed as pyogenic, tuberculous, and Cryptococcus abscesses before instituting any medical or surgical therapy. The pyogenic brain abscess had typical specific spectral findings (i.e., the demonstration of amino acids). Lactate and lipid peaks were visible in the tuberculous abscess. Cryptococcus neoformans can appear differently in different brain regions, which may lead to different spectral findings.

Diagnosis and endovascular treatment of acute thromboembolic renal artery occlusion presenting with abdominal pain.

Acute renal artery thromboembolic occlusion is seldomly encountered with respect to other central and peripheral ones. Patients may present with non-specific abdominal pain and renal colic. Organ functions can be preserved by means of endovascular treatment when early diagnosis is possible. Acute occlusion of renal arteries must be considered in the differential diagnosis of acute flank pain. This paper presents successful endovascular treatment of thromboembolic renal artery occlusion in two cases.

Pelvic incidence measurement with supine magnetic resonance imaging: A validity and reliability study.

OBJECTIVE: Classically, pelvic incidence (PI) and other spinopelvic sagittal parameters are measured using plain x-ray obtained with the patient standing. However, it is difficult to obtain a perfect mid-sagittal appearance of the sacral endplate and superimposition of both femoral heads from a plain x-ray. Overlapping of the iliac wings also could obscure the appearance of the sacral endplate. Recent studies showed that MRI was more reliable than x-ray for evaluating some spinal sagittal parameters. To our knowledge, measurements of spinopelvic sagittal parameters using supine MRI have not been reported previously. We assessed the validity and reliability of measurements of spinopelvic sagittal parameters from standing lateral x-rays and supine magnetic resonance imaging (MRI). METHODS: We recruited 26 asymptomatic volunteers for this study. Standing lateral lumbosacral radiographs, including femoral heads and spinopelvic MRI images with coronal images of the femoral heads were performed. The anatomic reference point required to measure PI was found on coronal MRI images and transferred to the midline sagittal MRI using the bladder wall as a second reference point. PI, sacral slope (SS), and pelvic tilt (PT) were measured on x-ray and MRI images. Validity and reliability of results also were tested. RESULTS: Of 14 males and 12 females (average age, 31.30), PI was obtained from x-ray and MRI in 52. ± 6.89 and 51.42 ± 6.43, respectively. From standing x-ray to supine MRI, PT decreased by 3.16°, while SS increased 2.5°. A paired t-test showed a significant difference between PT values from x-ray and MRI. The correlation was highest between the x-ray and MRI measurements of PI, PT, and SS, respectively. Intraobserver and interobserver reliabilities were between 0.88 and 0.96 on x-ray and MRI. All reliabilities were excellent, although MRI values were higher. CONCLUSION: MRI was more reliable in the measurement of spinopelvic parameters than classic standing x-ray examination. Higher reliability and being radiation-free could make MRI a good alternative to standing x-ray.

Study of the ureterovesical jet flow by means of dupplex Doppler ultrasonography in patients with residual ureteral stone after extracorporeal shock wave lithotripsy.

The aims of our study are to evaluate ureterovesical jet flow Doppler ultrasound (US) in patients with residual ureteral stone after extracorporeal shock wave lithotripsy (ESWL) and to compare with unobstructed contralateral ureter. Patients who have residual ureteral stone in intravenous pyelography (IVP) and/or computed tomography (CT) after ESWL and unobstructed contralateral ureter in 20 patients were prospectively evaluated with Doppler US. The mean peak velocity of the Doppler waveforms was obtained on the residual ureteral stone and contralateral non-obstructed ureter (17.10 +/- 20), (56.0 +/- 32), respectively (P < 0.05). In conclusion, due to the absence of contraindications and side-effects, Doppler US is sensitive and highly specific that can contribute significantly to the diagnosis of residual ureteral stone after ESWL. It can replace IVP and/or CT, in condition where IVP is undesirable and in addition Doppler US can supply a functional investigation of the obstructed ureter.

Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach.

AIM: Shoulder MR arthrography has an important role in the assessment of rotator cuff lesions, labral tears, glenohumeral ligaments, rotator interval lesions, and postoperative shoulder status. Injection in direct MR arthrography can be performed with palpation, fluoroscopy, ultrasonography (US), or MRI. Recently, the posterior approach is the preferred method due to the presence of fewer stabilizers, absence of important articular structures and less extravasation, has been advocated. Our aim was to assess the efficacy of US-guided MR arthrography via a posterior approach on the glenohumeral joint. MATERIALS AND METHODS: Thirty MR arthrographies were performed on 29 patients. Ultrasonography (Xario, Toshiba) examinations were conducted by a wide-band 5-12 Mhz linear array transducer set to muscle-skeleton. Diluted contrast medium (1 ml gadolinium chelate and 100 ml saline, approximately 15 ml) was delivered into the glenohumeral joint space from between the humeral head and posterior labrum with a 20-gauge spinal needle. MRI examination was conducted by a 1.5 T scanner. Fat-saturated T1-weighted spin echo was applied on coronal, axial, and sagittal planes within the first 30 min after contrast material injection. RESULTS: One (3.3%) arthrography was not successful due to technical reasons associated with obesity. Contrast extravasation around the infraspinatus and teres minör muscles was depicted in twelve examinations. One (3.3%) patient developed vasovagal collapse. CONCLUSION: Ultrasonography-guided posterior approach is an easy, reliable, fast, and comfortable method in experienced hands. It may be an alternative for fluoroscopy-guided shoulder MR arthrography.

Severe hemodynamic compromise due to left atrial compression by a dissecting aortic aneurysm.

Hemodynamically compromising left atrial (LA) compression by an aortic aneurysm is a rare entity. An 83-year-old woman with a previous diagnosis of congestive heart failure was admitted with worsening shortness of breath (NYHA grade III) and palpitations. The electrocardiogram showed atrial fibrillation. The chest X-ray revealed widening of the mediastinum and congested lung fields. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Thoracic three-dimensional magnetic resonance imaging showed LA compression by a descending aortic aneurysm and an intramural hematoma. No intimal flap was seen in any part of the thoracic aorta. Emergency surgery was planned, but the patient did not accept surgery and suddenly died after four days of admission. Focal descending aortic aneurysm with an intramural hematoma in the aortic wall causing nearly complete obliteration of the LA cavity has not been reported before.

Resistive index and peak systolic velocity for congenital talipes equinovarus: A color Doppler ultrasonography study.

OBJECTIVES: This study aims to investigate whether resistive index (RI) and peak systolic velocity (PSV) are suitable parameters to determine if a clubfoot differs from feet of the normal population. PATIENTS AND METHODS: Fifty-four feet of 27 clubfoot patients (22 males, 5 females; mean age 30.4±16.3 months; range, 5 to 72 months) were included in this retrospective study conducted between December 2017 and January 2019. Twenty-seven feet were conservatively treated, 19 had surgical treatment, and eight feet were healthy in patients with unilateral clubfoot. In addition, 22 feet of 11 normal controls (6 males, 5 females; mean age 33.4±15.3 months; range, 15 to 60 months) were studied. Color Doppler ultrasonography examinations were performed to evaluate the three major arteries of the leg and foot: dorsalis pedis (dp), tibialis posterior (tp), and popliteal (pop). Color filling, flow direction, spectral analysis, velocity, and RI were examined. RESULTS: With the exception of the dp artery RI, the PSV and RI values for all arteries differed significantly from those of the control group. There were no significant differences among the conservative, surgical, and healthy groups, while there were significant differences between each of the treated groups and the control group. Tibialis posterior artery PSV and pop artery RI were the best parameters to identify clubfoot and the cut-off points were 54 cm/second and 0.77, respectively. CONCLUSION: Peak systolic velocity and RI may be accepted as important parameters for identification of clubfoot deformity. Tibialis posteriorartery PSV and pop artery RI are the best- detailed parameters for this examination.

Spherical amyloid deposition in a prolactin-producing pituitary adenoma.

A 41-year-old man presented with headache, right-sided ophthalmic pain and visual deficit. His neurological examination was normal except for bitemporal hemianopsia and right lower quadranopsia. MRI demonstrated a mass arising from the pituitary gland. Hormonal analysis revealed an elevated prolactin level of 4700 ng/mL (normal 4.04-15.2 ng/mL). MRI revealed hypointense signal on T2-weighted images. Moreover, we also concluded that foci with no intravenous contrast enhancement represent the amyloid deposits. The patient underwent trans-sphenoidal resection of the pituitary adenoma. Histological examination revealed an adenoma with spheroid amyloid deposits adjacent to prolactin-staining adenoma cells. The patient recovered from the surgery without complications.

A Huge Ovarian Dermoid Cyst: Successful Laparoscopic Total Excision.

Giant ovarian cysts, ≥15 cm in diameter, are quite rare in women of reproductive age. Here, we present a case of ovarian cyst with unusual presentation treated by laparoscopic surgery. On histology, mass was found to be mature cystic teratoma. The diagnostic and management challenges posed by this huge ovarian cyst were discussed in the light of the literature.