Congenital imperforate hymen with bilateral hydronephrosis, polydactyly and laryngocele: A rare neonatal presentation.

Imperforate hymen is a rare congenital malformation to present with symptoms in the neonatal period. We present a case of a 5-day-old neonate with a marked interlabial swelling causing urinary retention. Imaging revealed hydrometrocolpos, hydrosalpinx, and bilateral hydronephrosis. Additionally, our patient had polydactyly of both feet and hands, and laryngocele that have not been previously described in literature. Hymenectomy is the mainstay of management to prevent the development of hematocolpos, pain, and possible retrograde menstruation.

Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis.

BACKGROUND: The aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation in plantar fasciitis. METHODS: A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up of 25.3 months with a 100-mm visual analog scale (VAS). RESULTS: There were significant improvements in plantar fascia thickness, fat pad thickness, and VAS. Among the three groups of ug-pg, ug-sg, and pg-sg there were no statistically significant differences after treatment (P = 0.017, MWU = 36.5; P = 0.023, MWU = 29.5; and P = 0.006, MWU = 13, respectively). CONCLUSIONS: The ug, pg, and sg injections were effective in the conservative treatment of plantar fasciitis. We are of the opinion that steroid injections should be performed, preferably with palpation or ultrasonographic guidance.

Portal vein hemodynamics in patients with non-alcoholic fatty liver disease.

Paralleling the rise in the incidence of obesity and diabetes worldwide, nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as one of the major causes of chronic liver disease. Doppler sonography is used as a diagnostic method in the non-invasive assessment of the hemodynamics of hepatic vascular flow in liver diseases. We investigated the effects of fatty infiltration in the liver on the Doppler flow hemodynamics of the portal vein. Doppler sonography of the liver and portal vein was performed in 60 subjects with NAFLD and 20 healthy volunteers (control). The patients were grouped into mild (grade 1), moderate (grade 2), and severe (grade 3) according to sonographic appearance of hepatosteatosis (n = 20 for each group). The vein pulsatility index (VPI), mean flow velocity (MFV), peak maximum velocity (V(max)), and peak minimum velocity (V(min)) of the portal vein were significantly lower in patients with NAFLD than those of the controls (p < 0.001). The VPI was 0.20 in the patients and 0.31 in the control. The MFV was 12.3 cm/sec in the patients and 16.5 cm/sec in the control group. The portal vein flow was found to be decreased as the grade of fatty infiltration increased for VPI (r = -0.946, p < 0.001), MFV (r = -0.951, p < 0.001). The alteration in Doppler waveform pattern of portal vein with fatty liver population suggests reduced vascular compliance in the liver.

Evaluation of the thyroid blood flow with Doppler ultrasonography in healthy school-aged children.

OBJECTIVE: To determine the relationship between thyroid blood flow and anthropometric measurements, pubertal stage, and thyroid and gonadotropic hormones. MATERIALS AND METHODS: We examined 123 healthy school-aged children prospectively (69 boys (56.1%) and 54 girls (43.9%), 7-17 years old). Their sex, age, body weight, height, body mass index (BMI), and pubertal stage were determined. Serum thyrotropin, free thyroxine, luteinizing hormone, and follicle stimulating hormone were measured in both genders, along with testosterone in boys and estradiol in girls. The peak systolic velocity (PSV), resistance index (RI), and pulsatility index (PI) of the superior thyroid artery were determined. The correlations between the Doppler parameters and these factors were investigated. RESULTS: There were no differences in age, weight, height, BMI, thyroid volume, PSV, RI, or PI between boys and girls (P>0.05). The PSV and PI showed strong correlations with age, height, weight, puberty stage, thyroid volume, and BMI. The RI showed a strong inverse correlation with age, height, weight, puberty stage, and thyroid volume and a weak inverse correlation with the BMI. CONCLUSION: Determination of the thyroid arterial flow in normal healthy children is important during a Doppler ultrasound (US) examination. Doppler US parameters and their percentiles should be described in healthy children from different age groups, and these percentiles will aid in interpreting Doppler US in children.

A rare cause of breast mass that mimics carcinoma: Foreign body reaction to amorphous surgical material.

A breast mass caused by foreign body type granulomatous reaction to surgical material is a very rare lesion and may mimic carcinoma. Reported foreign materials have included suture materials, silicone, paraffin, gunpowder and carbon particles used for localization of a nonpalpable breast lesions. To our knowledge, a foreign body reaction to gauze sponge has not been reported previously. A 58-year-old woman who had an enlarging mass that mimicked breast carcinoma, due to foreign body reaction to gauze sponge is presented here, and relevant literature is reviewed.

Assessment of the atlanto-occipital junction in the MRI of subjects with cervical disc herniation.

OBJECTIVE: To demonstrate the normal limits of Powers ratio and basion dens interval in patients with disc herniations. METHODS: The MRI of patients were retrospectively evaluated by 2 radiologists. Four hundred and forty-five patients who were admitted to Duzce University Hospital with neck pain without history of trauma were chosen between January 2004 and July 2006 in this retrospective study. The patients were between the ages of 14-80 years. RESULTS: Four groups were identified according to the number of disc herniations. The normal limits of Powers ratio and basion dens interval were 0.77+/-0.15 and 0.80+/-0.66 in group 0, 0.76+/-0.14 and 0.81+/-0.76 in group one, 0.75+/-0.13 and 0.80+/-0.71 in group 2, 0.76+/-0.14 and 0.81+/-0.74 in group 3, and 0.77+/-0.16 and 0.81+/-0.66 in group 4. The relationship between the number of disc herniations and Powers ratio and basion dens interval was not statistically significant. CONCLUSION: Our results were in concordance with the previous studies concerning the Powers ratio and basion dens interval. These 2 methods can be used in the MRI of atlantooccipital dislocation suspected patients with disc herniations.

The prevalence of venous insufficiency in patients with chronic obstructive pulmonary disease evaluated by color duplex ultrasonography.

OBJECTIVES: We hypothesized that in patients with chronic obstructive pulmonary disease (COPD) some extrapulmonary effects such as increase in intra-abdominal and intra-thoracic pressures, presence of cor pulmonale and pulmonary artery hypertension could cause venous insufficiency (VI) in the lower limbs. Our aim in this study was to assess the prevalence of VI in patients with COPD in comparison with healthy controls. METHODS: Thirty-nine male patients with COPD and 36 healthy male controls were evaluated for VI. All the participants were in the same age group and their smoking intensities were similar. Patients with COPD were classified as having mild, moderate, severe or very severe disease according to criteria of the Global Initiative for Chronic Obstructive Lung Disease. All the patients and control group were examined for unilateral or bilateral VI of the common femoral vein, superficial femoral vein, deep femoral vein and popliteal vein using color duplex ultrasonography. RESULTS: The prevalence of VI of the lower extremity in patients with COPD (69.2%) was significantly higher than in the healthy control group (41.7%). The prevalence increased as the COPD severity increased and VI was detected in all the patients with very severe COPD [mild COPD, 50.0% (2/4); moderate, 58.8% (10/17); severe, 75.0% (9/12); very severe, 100% (6/6)]. CONCLUSION: VI of the lower extremity appears more frequent in patients with COPD. We suggest ruling out COPD in patients with otherwise unexplained "primary" VI.

Floating ball appearance in ovarian cystic teratoma.

The presence of floating fat balls or globules in an ovarian cystic teratoma is an unusual finding. Herein, we present ultrasonographic and tomographic findings of a rarely reported case of cystic teratoma with a floating fat ball.

Measuring the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children.

OBJECTIVE: To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children. STUDY DESIGN: A prospective clinical study from June 2002 to May 2003. METHOD: A total of 64 children, aged 6-9 years who presented with nasal obstruction, snoring, mouth breathing, and hyponasal speech were examined and AN ratio was calculated by using the lateral neck radiograms and compared with the tympanometric values. The relationship between AN ratio and middle-ear pressure was evaluated, regarding the AN ratio of 0.71. The chi-square test was used to analyze the correlation between AN ratio and middle ear pressures and Wilcoxon test was used to compare the changes between the mean AN ratio values, and mean middle ear pressures (including A and C type tympanograms) before and after medical therapy. RESULTS: Middle-ear effusions and C type tympanograms in impedance audiometry were both related to eustachian tube dysfunction resulting from enlargement of the adenoids with AN ratios higher than 0.71. Middle ear pressures were found lower in children with AN ratio greater than 0.71 than in children AN ratio less than 0.71 and the difference was highly significant (p<0.001). Although medical treatment of large adenoids was rather effective to shrink the adenoid tissue (p<0.001), it did not cause a statistically significant change in tympanometric values (p>0.05). CONCLUSIONS: Antibiotherapy is effective in reducing adenoid size without signs and symptoms of infection. The reduction of the adenoids in size after 3 weeks of antibiotherapy has an positive effect on recovery of eustachian tube function but is not sufficient in patients with middle ear effusion. Early ventilation tube insertion may be an alternative therapy for the middle ear effusions not improving by 3 weeks medical therapy.

Laryngocele in association with ankylosing spondylitis.

A laryngocele is a cystic dilatation of the laryngeal saccule. The etiology of laryngoceles is unclear, but congenital and acquired factors are considered to play a role in their development. An acquired laryngocele may develop when the laryngeal ventricle becomes functionally obstructed as a result of an increase in intraglottic pressure, such as that caused by excessive coughing, playing a wind instrument, glass blowing or obstruction of appendicular ostium. We present a case of laryngocele in a patient with ankylosing spondylitis. To the authors' knowledge, and from a review of the literature, this combination has not been previously described. The laryngocele was also infected in this case. We believe that development of the laryngocele might be a result of increased intra-abdominal pressure, caused by rheumatoid arthritis, with associated increased intralaryngeal pressure.

Cerebral blood flow measurements of the extracranial carotid and vertebral arteries with Doppler ultrasonography in healthy adults.

PURPOSE: To establish normal cerebral blood flow volume by measuring flow volume of the extracranial carotid and vertebral arteries using Doppler ultrasonography in healthy adults. MATERIALS AND METHODS: A prospective study was performed with a group of 96 healthy adults aged 20 to 80 years (48 women, 48 men; mean age of all patients, 49.8 +/- 17.1). The common, external, and internal carotid arteries and the vertebral arteries (CCA, ECA, ICA, and VA, respectively) were examined using Doppler ultrasonography. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and luminal diameters of the vessels were measured, and flow volumes were calculated in all the arteries. The influence of age on these parameters was also investigated. RESULTS: In the CCA, ICA, and VA, all flow velocities and flow volumes decreased significantly with an increase in age. The luminal diameters of the carotid and vertebral arteries increased significantly with aging, while there was no significant alteration in the RI. The luminal diameters of the CCA, ICA, and ECA were significantly smaller in women than in men. PSV and EDV in the ICA, and EDV in the VA were significantly higher in men. There was no gender-linked difference in flow volumes of the brain-feeding arteries, however, in the ECA flow volumes were significantly higher in women. CONCLUSION: Normal cerebral blood flow volume was established by measuring the flow volume of the ECA and VA with Doppler ultrasonography in healthy adults. We believe that these data can be useful in evaluating cases with cerebrovascular disease, which are related to altered cerebral blood flow volume.

Breast arterial calcifications and carotid intima-media thickness and haemodynamics: Is there any association?

OBJECTIVE: In this study, we aimed to research the relation between breast arterial calcifications (BACs) detected on mammography and two well-known markers of cardiovascular diseases-carotid artery intima-media thickness (C-IMT) and haemodynamics parameters like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). METHODS: The study group consisted of 50 consecutive BAC (+) women and the control group consisted of 55 BAC (-) women. In all participants, BAC was diagnosed using mammography and C-IMT was measured using B-mode and Doppler ultrasonography. BAC was defined as two linear calcification depositions in a conical periphery or as calcific rings at the mammographic evaluation. Doppler spectrum samples were obtained from 2 cm proximal to the main carotid artery bifurcation. RESULTS: Postmenopausal female patients ranging in age from 40 to 86 included in this study. When the groups were adjusted for age, a statistically significant difference was found between mean C-IMT of BAC (+) and BAC (-) groups (0.81 ± 0.2 vs. 0.69 ± 0.2 mm; p<0.001). No significant differences were observed between BAC (+) and BAC (-) groups in terms of PSV, EDV, RI. CONCLUSION: The findings of the present study suggest that BAC, diagnosed by mammography, is independently associated with C-IMT. C-IMT measurement is suggested as a useful tool to detect early atherosclerotic changes. However, haemodynamic variables (PSV, EDV, RI) were not statistically different between the BAC (+) and BAC (-) groups. Prospective larger cohort studies are needed to further elucidate whether BAC is an independent risk factor for cardiovascular disease.

Relation between radiographic BI-RADS scores and triple negativity in patients with ductal carcinomas.

UNLABELLED: The aim of this study was to investigate association of radiographic (BI-RADS 4 and 5) results and prognostic factors of invasive ductal carcinomas with their histopathological subtypes. A total of 103 patients histopathologically diagnosed with invasive ductal carcinoma of breast with in last five years period were enrolled. Of them, 69 patients who had radiological reports in were included from registry of Radiology Department; Duzce University Training and Research Hospital archives. BI-RADS scores (4 and 5) of radiological reports and subtypes of ductal carcinoma were compared. Of 69 cases, 12 of 22 cases with BIRADS 4 score were Triple negative (TN) while 5 of 47 cases with BIRADS 5 score were TN (p = 0.001). The patients with TN tumors were found to have lower average age, higher grade, higher Ki67 proliferative index and fewer lymph node metastasis than those with non-TN ductal carcinomas (p = 0.048; 0.019; 0.02; 0.048 respectively). CONCLUSIONS: Patients who had radiological BIRADS 4 score were significantly more frequent TN type carcinoma than BI-RADS 5. It is important to pay attention to this issue when clinicians evaluate patients with BI-RADS 4 score breast lesions.

Relationship between breast arterial calcifications detected on mammography and brachial artery intima-media thickness.

PURPOSE: Although breast arterial calcification (BAC) was shown to be related with coronary artery disease (CAD), hypertension (HT), diabetes mellitus (DM) and carotid intima-media thickness (C-IMT), but the association between BAC and brachial intima-media thickness (B-IMT) has not been evaluated yet. Our aim was to investigate whether associations existed between BAC and measure B-IMT and atherosclerosis (AS) by comparing these patients with healthy control subjects. METHODS: A Total of 75 patients were included in the study. Subjects with or without BAC were assigned into one of two groups and those with a BAC were graded. Main brachial artery IMT was measured. RESULTS: When the effect of age was partialled out statistically, we found a statistically significant difference in mean B-IMT between BAC (+) (0.54 ± 0.09) and BAC (-) (0.45 ± 0.08) groups (p = 0.001) after the groups were adjusted for age. CONCLUSIONS: In conclusion, even though the relationship between B-IMT and BAC was significant, like the relationship between C-IMT and BAC, significant age difference between BAC (+) and BAC (-) groups and no significant relationship between BAC and time after menopause, after adjustment for age, suggest a strong association between BAC and age rather than AS. This can be elucidated by pathological correlation studies in larger series of subjects.

Bronchial wall thickness in toll collectors.

There is an increasing concern about the possible adverse effects of diesel exhaust particulates on human health. In a diesel exposed occupational group composed of 120 toll collectors, a cross-sectional study was performed to evaluate the chest radiographs and 40 toll collectors were selected for computed tomography examination according to hyperinflation and linear markings. The wall thicknesses and luminal diameters of trachea, main bronchi, and segmental bronchi of right apical and posterior basal segments were measured with manual tracing method. The walls of right upper bronchus in exsmoker toll collectors were significantly thicker than those of nonsmokers (p=0.011). A positive correlation was observed between age and the right upper bronchus wall thickness (r=0.577, p=0.000). An inverse correlation was found between the working duration and the diameter of right main bronchus (r=-0.366, p=0.020). A positive correlation was seen between smoking and the right upper bronchus wall thickness (r=0.457, p=0.005). Diesel exposure might have a role in increase of thickness of large airways wall and a decrease in the diameters of large airways. Studies in this area are needed to protect the population under the diesel exposure risk.

Doppler waveforms of the hepatic veins in children with diffuse fatty infiltration of the liver.

OBJECTIVE: The aim of this study was to investigate the effect of fatty infiltration of the liver (FIL) on the Doppler waveform pattern in the hepatic veins of obese children. METHODS: In this prospective study, 59 patients with diffuse FIL and 45 normal healthy children who served as control group underwent hepatic vein B-mod and duplex Doppler sonography. The Doppler sonography spectrum of the right hepatic vein was classified into three groups: triphasic waveform, biphasic waveform, and monophasic or flat waveform. RESULTS: There was a statistically significant difference in the phasicity of hepatic venous flow between patients and control subjects (p<0.001). The Doppler flow pattern in the right hepatic vein was triphasic in 28 (47.5%), biphasic in 28 (47.5%), and monophasic in 3 (5%) children with fatty liver, while it was triphasic in 43 (95.6%) and biphasic in 2 (4.4%) control subjects. There was an inverse correlation between the sonographic grade of fatty infiltration of the liver and the phasicity of hepatic venous flow (r=-0.479, p<0.001). CONCLUSIONS: Abnormal right hepatic vein Doppler waveform, biphasic as well as monophasic, can be seen in healthy obese children with diffuse FIL.

Comparison of the three age estimation methods: which is more reliable for Turkish children?

BACKGROUND: Three atlases-the GOK, the Greulich-Pyle (GP), and the Tanner-Whitehouse (TW3)-are used frequently for age determination in Turkey. The purpose of this study was to evaluate the applicability of these three methods related to the skeletal age assessment for Turkish adolescents. MATERIALS AND METHODS: The conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (+/- standard deviation [S.D.] in years) between the chronologic age (CA) and the skeletal age (BA), which were obtained by using each age estimation method, were calculated and tested using t-test. RESULTS: For girls, the most accurate method was the TW3 (mean differences (d): -0.21 (p<0.05)), following by the GP (d: 0.66 (p<0.001), and the GOK (d: 2.99 (p<0.001)). For boys, the most accurate method was the GP (d: -0.02 (p>0.05)), followed by the TW3 (d: -0.18 (p<0.05)) and GOK (d: 1.05 (p<0.001)). DISCUSSION AND CONCLUSIONS: Results show that the TW3 (for girls) and the GP (for boys) methods are more appropriate than the GOK atlas for estimating the BA. GOK could be used for boys aged 11-14 years but it should not be used for girls.

Hydrocele of the canal of Nuck: sonographic and MRI appearances.

Hydrocele of the canal of Nuck is a rare disorder in females. A 50-year-old female presented with the complaint of swelling and occasional pain in the right groin. Sonographic examination revealed a proximal dilatation at the inguinal canal with a 3-cm ovoid, septated cystic lesion at the distal end. The mass appeared as a simple cyst on MRI. Valsalva's maneuver during real-time sonography helped differentiate the hydrocele of the canal of Nuck from an inguinal hernia.

Orbital blood flow velocities in patients with rheumatoid arthritis.

PURPOSE: To assess orbital blood flow changes in patients with rheumatoid arthritis using Doppler sonography. PATIENTS AND METHODS: The study comprised 35 patients who were diagnosed with RA and were treated at the Department of Physical Therapy and Rehabilitation at Duzce Medical School. A control group consisted of 35 healthy volunteers. Color Doppler imaging was used to measure peak systolic velocity (PSV) and end diastolic velocity (EDV), from which the resistance index (RI) was calculated in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCAs). RESULTS: In the OA, PSV, EDV, and RI were, respectively, 36.7 +/- 0.6 cm/sec, 9.7 +/- 0.2 cm/sec, and 0.73 in the control group versus 34.7 +/- 3.0 cm/sec, 9.1 +/- 1.1 cm/sec, and 0.74 in the patient group. In the CRA, they were, respectively, 11.8 +/- 1.7 cm/sec, 3.6 +/- 0.7 cm/sec, and 0.66 in the control group versus 11.1 +/- 1.7 cm/sec, 3.4 +/- 0.7 cm/sec, and 0.68 in the patient group. In the PCAs, they were, respectively, 13.2 +/- 1.2 cm/sec, 4.7 +/- 0.6 cm/sec, and 0.65 in the control group versus 12.4 +/- 1.2 cm/sec, 4.2 +/- 0.6 cm/sec, and 0.66 in the PCAs. PSV, EDV, and RI of the PCAs and OA and RI of the CRA were significantly different between patients and controls, whereas there was no difference in the serum levels of glucose, triglyceride, low-density lipoprotein cholesterol, and total cholesterol. In the patient group, there was a significant correlation between orbital blood flow and duration of disease. CONCLUSION: Ocular blood flow appears to be slightly lower in RA patients than in healthy controls, suggesting that RA is a systemic inflammatory disease that may also involve ocular vessels.