Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL.

OBJECTIVE: To analyze the contribution of multiparametric MRI and PCA3 assay, predecision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). MATERIALS AND METHODS: PSA level 3-10 ng/mL, patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. RESULTS: 53 patients were included between February 2013 and March 2014. Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3's PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. CONCLUSION: Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

Direct high-pressure Injury of the Palm after Injection of a Capsaicin-filled Gas Pistol. / Direkte Hochdruckinjektionsverletzung mit einer Capsaicin gefüllten Gaspistole in die Hohlhand.

High injection lesions of the hand are among the most serious injuries, with concomitant consequences. These lesions are often underestimated and may entail additional damages if that is the case. Not only the physical impact but also the chemical nature of the substance dictate the treatment.

There may be a role for hyperbaric oxygen therapy in transient osteoporosis of the hip.

Transient osteoporosis of the hip (TOH) is a rare clinical condition with usually an unknown aetiology and which typically develops in middle-aged men, or in women in the third trimester of their pregnancy. It is characterized by transient osteopenia and by gradually increasing pain associated with a limitation of the range of motion of the hip. Bone marrow oedema is a typical but nonspecific finding in TOH. A 33-year-old female patient presented with severe hip pain one month after delivery. Her history was unremarkable except for a Hashimoto's Disease of 8 years' duration. Magnetic resonance imaging (MRI) showed significant bone marrow oedema with increased signal intensity in the femoral head on T2-weighted images. A diagnosis of TOH was made and the patient received a total of 30 sessions of hyperbaric oxygen (HBO) at 2.4 ATA, 2 hours each, in a multiplace chamber. Over the course of HBO treatment, her pain was gradually relieved and she became asymptomatic after one month together with a complete recovery of the range of motion of the hip. MRI of the hips 10 weeks after onset of HBO therapy showed normal signal intensity on T2-weighted images.

Orthognathic surgical planning on three-dimensional stereolithographic biomodel.

The aim of this report was to present the orthognathic surgical planning of a patient with maxillary retrusion, mandibular prognathism, and midline shift on a three-dimensional stereolithographic biomodel. A patient who complained about facial deformity and difficulty in chewing was referred to our department. After a short-term presurgical orthodontic treatment, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were performed. Triangular axial gaps occurred anteriorly and posteriorly between the proximal and distal segments of the osteotomized mandible. These gaps were filled with bone grafts in accordance with templates that were constructed on a three-dimensional stereolithographic biomodel. Rotational movement of the distal mandibular segment around the y axis caused axial triangular gapping between the proximal and distal mandibular segments. In the presented case, orthognathic surgical planning was performed on the three-dimensional solid models, and templates were reconstructed according to these gaps. These templates were used to determine the size of the bone grafts during the surgical approach. The patient was diagnosed with lateral cephalometric and posteroanterior cephalometric analysis in postretention for 2 years, and it was determined that long-term results were perfect and skeletal relapse did not occur after 2.5 years of surgery. Movement at the site of the osteotomy is usually the main cause of relapse after orthognathic surgery. In the presented case, a three-dimensional stereolithographic biomodel was used to plan the orthognathic surgery and to reconstruct the templates to determine the size and shape of the bone grafts. Using bone grafts established close contact between proximal and distal osteotomized bone segments, enhanced bone healing, and diminished relapse risk.

Paranasal sinus mucosal hypertrophy in experienced divers.

INTRODUCTION: Due to the increasing popularity in recreational diving long-term health consequences of this sport have aroused interest in the diving community. Although not as important as dysbaric osteonecrosis, ischemic brain lesions, or neurophysiological symptoms, paranasal sinus mucosal hypertrophy (PSMH) has also been discussed as being more prevalent among divers. In this study, we used magnetic resonance imaging (MRI) to compare asymptomatic divers with control subjects for PSMH. METHODS: We enrolled 79 male divers (34.0 +/- 5.7 yr) and 79 nondiving age- and sex-matched controls (33.8 +/- 6.1 yr). We used a questionnaire to elicit diving history. Divers with a history of sinus barotrauma, subjects with a history of chronic sinusitis or nasal allergies, and those with retention cysts, nasal polyps, or mastoiditis were excluded. T1-, T2-weighted axial and coronal images of the paranasal sinuses were taken with a 1.5-T MRI device. The threshold for PSMH was defined as mucosal thickness above 3 mm. RESULTS: MRI revealed PSMH in 33 (41.8%) divers and 18 (22.8%) controls. There were no significant differences between the groups with respect to age, smoking history, or alcohol consumption. PSMH identified in divers did not show an association with age or diving history. DISCUSSION: The higher rate of PSMH identified in divers suggests that diving may cause changes in the paranasal sinus mucosa.

Arterial supply of the posterior interventricular sulcus: a CT coronary angiographic study.

OBJECTIVE: The objective of this study was to determine the different vascularization patterns of the posterior interventricular sulcus (PIS) with coronary CT angiography. MATERIALS AND METHODS: Three hundred and fifty-six coronary CT angiograms (CCTA) were retrospectively analyzed in 248 men and 108 women (mean age, 54.9 years ± 13.6 [standard deviation]). The PIS was divided into three segments from the crux cordis to the notch of the cardiac apex according to the American Heart Association classification (basal, mid ventricular and apical), and the artery or arteries supplying each segment were recorded. The relative frequency of the different vascularization patterns was calculated and the distribution of dominance types was recorded. RESULTS: Blood was supplied to the PIS by one or more branches of the right coronary artery (RCA), the left circumflex artery (LCX), or the left anterior descending artery (LAD). We observed 25 different irrigation patterns. In the most frequent pattern (31.3%), the basal and mid-ventricular segments were perfused by a single arterial branch originating from the RCA at the crux, and the apical segment was perfused by the LAD traveling beyond the notch of the cardiac apex and entering the posterior interventricular sulcus. Of the 356 cases, the circulation was right dominant in 310 (87.1%), left dominant in 34 (9.5%), and balanced in 12 (3.4%) cases. Individual segments were perfused by a single artery in 288 (80.9%) cases, and by more than one in the remainder. CONCLUSION: CCTA allows detailed assessment of the arterial supply of the PIS, and allowed to describe 25 subtypes. This information is of potential value to both cardiac surgeons and interventional cardiologists who plan bypass surgery or angioplasty aiming at the posterior interventricular artery.

Computed tomography findings in diseases of the adrenal gland.

The adrenal gland is a common site of disease, with an abnormality prevalence as high as 9% in autopsy series. With the increasing use of CT, adrenal lesions are frequently found in the daily practice of radiology and are diagnosed in up to 5% of CT examinations performed for varied reasons. Imaging features on CT can establish a specific diagnosis of many of these lesions, including myelolipoma, hematoma and cysts. Once a diagnostic dilemma, now adenomas can be accurately diagnosed using unenhanced CT, chemical shift magnetic resonance imaging and CT contrast washout analysis. Because the adrenal gland is also a frequent site of metastasis, recent literature has focused on imaging characterization of adrenal masses for differentiation of adenomas from metastases. In patients without known malignancy, most adrenal lesions are benign and a specific diagnosis can now be made on the basis of imaging features. It is important to understand the prevalence of adrenal abnormalities because the gland is a common site of disorders, and the increased use of cross-sectional imaging has increased the frequency of detection of adrenal lesions. The prevalence of disease is important in predicting the risk of malignancy when an adrenal mass is discovered in a patient without known cancer. Detection of adrenal gland diseases has increased substantially with the advent and widespread use of imaging techniques. Although several imaging modalities can be used, CT has a central role in both detection and differential diagnosis of an adrenal lesion. The aim of this article is to review the CT findings of adrenal gland diseases.

Cerebral white-matter lesions in asymptomatic military divers.

INTRODUCTION: There is some concern that over a period of years, diving may produce cumulative neurological injury even in divers who have no history of decompression sickness. We evaluated asymptomatic divers and controls for cerebral white-matter lesions using magnetic resonance imaging (MRI). METHODS: The study enrolled 113 male military divers (34.4 +/- 5.6 yr) and 65 non-diving men (33.1 +/- 9.0 yr) in good health. Exclusion criteria included any condition that might be expected to produce neurological effects. Patent foramen ovale was not assessed. A questionnaire was used to elicit diving history. A 1.5-T MRI device was used to acquire T1, T2-weighted, and fluid attenuated inversion recovery (FLAIR) images of the brain. A lesion was counted if it appeared hyperintense on both T2-weighted and FLAIR images. RESULTS: MRI revealed brain lesions in 26 of 113 divers (23%) and in 7 of 65 (11%) controls, a difference that was statistically significant. There was no significant difference between the groups with respect to blood pressure, smoking history, or alcohol consumption, and no subject reported a history of head trauma or migraine. There was no relationship between MRI findings and age, diving history, or lipid profile in divers. DISCUSSION: The higher incidence of lesions in the cerebral white matter of divers confirms the possibility that cumulative, subclinical injury to the neurological system may affect the long-term health of military and recreational divers.

MRI findings of intracranial tuberculomas.

PURPOSE: Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis. METHODS: We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients. RESULTS: A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient. CONCLUSION: MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

Sonographic appearances of the normal ulnar nerve in the cubital tunnel.

PURPOSE: To investigate the sonographic characteristics of the normal ulnar nerve in the cubital tunnel, as well as any differences related to age, sex, and dominant arm. METHOD: Two hundred twelve elbows in healthy volunteers were evaluated sonographically. The cross-sectional area (CSA) of the ulnar nerve within the cubital tunnel was measured with the elbow in extension and in flexion. The presence and number of fascicles was determined. The displacement of the ulnar nerve out of the cubital tunnel in full elbow flexion was also investigated. RESULTS: The mean +/- SD CSA of the ulnar nerve was 6.6 +/- 1.7 mm(2) (6.7 +/- 1.8 mm(2) in men and 6.5 +/- 1.7 mm(2) in women). The mean CSA of the ulnar nerve was highest for subjects aged 50-59 years, and lowest for subjects aged 30-39 years. Forty-two of 212 (19.8%) ulnar nerves had 2 fascicles, and 5 (2.4%) had 3 fascicles. The remaining 165 (77.8%) nerves had 1 fascicle. During elbow flexion, 49 of 212 (23.1%) ulnar nerves showed subluxation, and 18 (8.5%) were dislocated. CONCLUSION: There were differences in the CSA of the ulnar nerve between some age groups, but there was no variation with sex or handedness. Sonography can evaluate the morphologic changes of the nerve during flexion of the elbow.

Osteochondritis dissecans of the tarsal navicular.

A 27-year-old male athlete presented with chronic right dorsal midfoot pain and limitation in midfoot movements. Computed tomography and magnetic resonance imaging demonstrated an nondisplaced osteochondral fragment within the proximal articular surface of the tarsal navicular. Imaging findings of this disease are presented and discussed.

Dysbaric osteonecrosis screening in Turkish Navy divers.

INTRODUCTION: Dysbaric osteonecrosis (DON) is regarded as an occupational disease for caisson workers, commercial, and military divers. Magnetic resonance imaging (MRI) was suggested for the surveillance of military divers for DON. This study aimed to determine the prevalence of DON in Turkish Navy divers. METHODS: The shoulder, hip, and knee joints of 106 male divers were screened for DON with MRI. A questionnaire was used to obtain information about subjects' medical history and diving experience. RESULTS: The mean age of divers was 34.3 +/- 5.8 yr. The divers had spent an average of 12.1 +/- 6.1 yr at their occupation. The average of total hours of diving was 834 +/- 458 h. The maximum diving depth was 53.0 +/- 18.4 m (175 +/- 61 ft) and the average diving depth was 13.3 +/- 8.4 m (44 +/- 28 ft). MRI examinations of divers did not reveal bone lesions consistent with osteonecrosis. DISCUSSION: We concluded that the risk of DON is very low for military divers who strictly obey the decompression rules and who undergo periodic medical examination. The use of MRI for routine screening of military divers is not justified.

Spirometric changes after pleural decortication in young adults.

BACKGROUND: The collection of pleural fluid and thickened pleura restrict the movement and expansion of lung. The main treatment strategy is lung decortication for the thickened pleura. The aim of this study was to investigate lung functions before and after pleural decortication in young adults. METHODS: A total of 63 patients with thickened pleura were retrospectively evaluated. Before the operation, patients with tuberculosis (n = 36) were treated with anti-tuberculosis therapy for 3-6 months. Patients with non-tuberculosis causes (n = 27) had been treated with broad-spectrum antibiotics. Forced expiratory volume in 1 s (FEV1, %), forced vital capacity (%) and vital capacity (litre) were measured before and after decortication. RESULTS: Spirometric parameters FEV1 (68.1 +/- 16.7 vs 71.01 +/- 14.4), forced vital capacity (67.6 +/- 16.4 vs 71.3 +/- 14.4) and vital capacity (2.6 +/- 0.6 vs 2.8 +/- 0.7) significantly improved after the operation (P +/- 0.01). Spirometric changes were not significantly different between tuberculosis and non-tuberculosis groups. CONCLUSION: Pleural decortication may improve the lung restoration in patients with thickened pleura and also improve lung functions significantly in young adults.

Imaging of pulsatile tinnitus: a review of 74 patients.

OBJECTIVE: Our aim was to assess the effectiveness of imaging modalities in detecting the underlying pathologies in patients with pulsatile tinnitus. MATERIALS AND METHODS: Seventy-four patients with pulsatile tinnitus were radiologically evaluated. All patients except two are evaluated on a thin-section bone algorithm computed tomography scan covering the temporal bone and skull base, 14 patients with or without contrast-enhanced brain computed tomography, 7 patients with magnetic resonance imaging and magnetic resonance angiography, 5 patients with digital subtraction angiography, and 12 patients with Doppler ultrasonography. RESULTS: The underlying pathology of tinnitus was detected in 50 patients (67.6%), and 24 patients were normal with radiologic studies. The most common cause was high jugular bulbus (21%) followed by atherosclerosis, dehiscent jugular bulbus, aneurysm of internal carotid artery, dural arteriovenous fistula, aberrant internal carotid artery, jugular diverticulum, and glomus tumor. CONCLUSION: It was concluded that radiologic imaging methods are effective in detecting the underlying pathology of pulsatile tinnitus.

The effect of pharyngeal soft tissue components on snoring.

OBJECTIVE: To determine the effect of oropharyngeal air column area, parapharyngeal fat pad thickness, pterygoid muscle thickness, and parapharyngeal wall thickness on snoring. MATERIALS AND METHODS: Fifty-six individuals (35 men, 21 women) complaining of snoring in a questionnaire administered to patients attending the MR unit for cervical MR imaging were enrolled as the study group, and 39 (23 men, 16 women) individuals with no complaint of snoring were enrolled as the control group. Firstly, patients' body mass index (BMI) was determined. Then turbo spin echo T2-weighted MR imaging in the axial plane was performed, from the nasopharynx to the hyoid bone level, in both groups. From the MR images, oropharyngeal air column area, parapharyngeal fat pad thickness, pterygoid muscle thickness and parapharyngeal wall thickness measurements were made. Finally, the results were statistically analysed using SPSS (Statistical Package for Social Sciences) for Windows 10.0. Student's t-test was used as a complementary method in the analysis of the study data. The correlations between BMI and parapharyngeal wall thickness, and BMI and oropharyngeal air column area were determined by Pearson's correlation analysis. RESULTS: No statistically significant difference was found between study and control groups in terms of mean age, pterygoid muscle thickness, or pharyngeal fat pad thickness (P>.05). Snorers' BMI levels (P<.01) and average parapharyngeal wall thicknesses (P<.05) were statistically significantly higher than those of the control subjects. Snorers' oropharyngeal air column area was significantly narrower than that of the control subjects, statistically (P<.01). CONCLUSION: As a result of the study, it was concluded that only oropharyngeal air column area and parapharyngeal muscle thickness had an effect on snoring.

Diagnostic value of CTE in patients with Crohn's disease.

OBJECTIVE: The goal of our study was to compare the accuracy of computed tomography enteroclysis (CTE) to that of biopsy in detecting bowel wall alterations of the terminal ileum in Crohn's disease (CD). SUBJECTS AND METHODS: A total of 43 patients with either diagnosed or suspected CD (16 females, 28 males) underwent CTE and ileoscopy. Ileoscopy diagnosed 35 patients with CD of the ileum, while 8 patients served as the control group. RESULTS: Computed tomography enteroclysis detected CD in 31 patients (88%) and in none of the control group. According to the criteria used for evaluation of small bowel loop distension, 31 cases were (72%) with optimal distension, nine cases (%21) with good distension, and three cases (7%) with poor distension. Computed tomography enteroclysis showed that mean ileal wall thickness in patients with CD was 6.8 mm (range, 9.5-4.1 mm) and 1.79 mm in patients in the control group (range, 2.20-1.38 mm). Mean postcontrast wall density in patients with CD was 81.9 HU (range, 111.6-52.2 HU) and 41.1 HU (range, 49.8-22.4 HU) in the control group. Mean postcontrast wall density in 17 patients with active CD was 97 HU (range, 67-123 HU) and 62 HU (range, 46-87 HU) in 18 CD patients in remission. We calculated that the overall sensitivity and specificity of CTE in detecting the severity of CD were 89% and 100%, respectively. Positive predictive value was 100%; negative predictive value was 89%. CONCLUSION: Our results indicate that CTE can reveal CD involvement of small bowel accurately and allow assessment of the degree of disease activity.