RESUMEN
Fractures of the transverse processes in the lumbar vertebrae occur as the result of major forces such as direct blunt trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle, or Malgaigne fractures of the pelvis. Dancers make repeated and forceful hyperextension and flexions of the spine, which may cause fractures of the transverse processes of the lumbar vertebrae. Repeated trauma of muscles in dancers may cause avulsion fractures and myositis ossificans. Herein, we report MRI and CT findings of an avulsion from the right transverse process of the L2 and L3 vertebrae in a 16-year-old professional teenage dancer, who responded to conservative treatment.
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Calcinosis/etiología , Baile/lesiones , Vértebras Lumbares/lesiones , Miositis Osificante/etiología , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/terapia , Adolescente , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Miositis Osificante/diagnóstico por imagen , Miositis Osificante/patología , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/patología , Resultado del TratamientoRESUMEN
OBJECTIVES: The objective of the study was to assess the value of visual assessment of signal intensities on b800 diffusion-weighted images and apparent diffusion coefficient (ADC) maps in differentiation of benign and malignant focal liver lesions (FLLs). METHODS: Approval for this retrospective study was obtained from the institutional review board. One hundred forty-three FLLs in 65 patients (38 women, 27 men; mean age, 50.8 years) underwent magnetic resonance (MR) imaging and diffusion-weighted imaging (DWI) with a respiratory-triggered single-shot echo-planar imaging sequence. Focal liver lesions were evaluated visually according to the signal intensities on b800 and ADC map images, and ADC values were also calculated. The conventional MR imaging, follow-up imaging findings, and histopathologic data were regarded as gold standard. Normal distribution was assessed with Kolmogorov-Smirnov test. The accuracies of visual assessment and ADC values in differentiating benign and malignant FLLs were assessed with the Student t test, and threshold values were determined with receiver operating characteristic curve analysis. RESULTS: By using a cutoff value of 1.21 × 10⻳ mm²/s, ADC had a sensitivity of 100%, a specificity of 89.3%, and an accuracy of 92.3% in the discrimination of malignant FLLs. With the visual assessment of the DWIs and ADC maps, malignant lesions were differentiated from benign ones, with 100% sensitivity, 92.2% specificity, and 94.4% accuracy. Although some benign lesions were interpreted as malignant, no malignant lesion was determined as benign in visual assessment. CONCLUSIONS: Most FLLs are benign ones such as hemangiomas and cysts, which can be readily and practically characterized only by using visual assessment of DWIs without requiring time-consuming conventional and dynamic contrast-enhanced imaging sequences. Some benign lesions that are falsely interpreted as malignant can be further characterized by using conventional and contrast-enhanced MR studies.
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Imagen de Difusión por Resonancia Magnética/métodos , Hepatopatías/diagnóstico , Medios de Contraste , Diagnóstico Diferencial , Imagen Eco-Planar , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Meglumina/análogos & derivados , Persona de Mediana Edad , Compuestos Organometálicos , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
INTRODUCTION: The aim of this study was to evaluate the position and movements of the tongue in patients with skeletal Class III malocclusion. METHODS: Sixty-six patients (31 male, 35 female) with Class III malocclusion were divided into 3 groups according to cephalometric analysis. The first group comprised 23 patients (13 male, 10 female) with mandibular prognathism, the second group comprised 21 patients (9 male, 12 female) with maxillary retrognathism, and the third group comprised 22 patients (9 male, 13 female) with both maxillary retrognathism and mandibular prognathism. Twenty-two skeletal Class I patients (10 male, 12 female) were also included as the control group. RESULTS: Dentofacial morphology affects the position and the movements of the tongue during deglutition. Contact of the anterior portion of the tongue with the rugae area of the hard palate decreased in the Class III malocclusion groups. The posterior portion of the dorsal tongue was positioned more inferiorly, and the root of the tongue was positioned more inferiorly and anteriorly in patients with Class III malocclusion than in the control group. The tip of the tongue was also in a more anterior position in the Class III groups. When the deglutition stages were evaluated, we observed that the manner of bolus transfer was different in patients with skeletal Class III malocclusion than in those with skeletal Class I malocclusion. CONCLUSIONS: Tongue posture is affected by dentofacial structures, and adaptive changes occur in the tip, dorsum, and root of the tongue. Deglutitive tongue movements in patients with skeletal Class III malocclusion are also different from those with skeletal Class I malocclusion.
Asunto(s)
Deglución/fisiología , Imagen Eco-Planar/métodos , Imagen por Resonancia Cinemagnética/métodos , Maloclusión de Angle Clase III/fisiopatología , Lengua/fisiopatología , Adaptación Fisiológica/fisiología , Adolescente , Cefalometría/métodos , Esófago/patología , Femenino , Humanos , Masculino , Maloclusión Clase I de Angle/fisiopatología , Mandíbula/patología , Maxilar/anomalías , Maxilar/patología , Movimiento , Hueso Nasal/patología , Paladar Duro/patología , Paladar Blando/patología , Prognatismo/fisiopatología , Estudios Prospectivos , Retrognatismo/fisiopatología , Lengua/patología , Adulto JovenRESUMEN
INTRODUCTION: The aim of this study was to evaluate the deglutitive tongue movements in patients with skeletal Class II malocclusion. METHODS: Fifty-nine patients (26 male, 33 female) with skeletal Class II relationship were divided into 3 groups according to cephalometric analysis. Group 1 (n = 19) had mandibular retrognathism, group 2 (n = 20) had maxillary prognathism, and group 3 (n = 20) had both mandibular retrognathism and maxillary prognathism. Twenty-two skeletal Class I patients (10 male, 12 female) were also included as the controls. RESULTS: In the mandibular retrusion group, the posterior portion of the dorsal tongue moved downward at stage 2 and upward at stage 3; the root of the dorsal tongue was in an inferior and anterior position at stage 2. In patients with both mandibular retrognathism and maxillary prognathism, the middle portion of the dorsal tongue was positioned superiorly at stage 3 relative to stage 1; the tongue tip was retruded at stage 3 relative to stages 1 and 2. In the control group, the middle portion of dorsal tongue was positioned superiorly at stage 3 relative to stages 1 and 2; the posterior portion of the tongue moved upward at stage 2 and downward at stage 3, and tongue-tip retrusion was observed at stage 2 relative to stage 1. Contact of the anterior portion of the tongue with the rugae area of the hard palate decreased in the Class II malocclusion groups relative to the control group. The middle portion of the dorsal tongue was positioned more superiorly in patients with Class II malocclusion during all stages of deglutition. The root of the tongue was more inferior and anterior, and the tongue tip was retruded in patients with Class II malocclusion compared with the control group. The posterior portion of the dorsal tongue was more inferiorly positioned in patients with mandibular retrusion than in the other Class II groups or the controls. In the third stage of deglutition, this portion of the tongue had a superior position in groups 2 and 3 relative to the control group. CONCLUSIONS: Dentofacial morphology affects the position and movements of the tongue during deglutition, and adaptive changes occur in the tip, dorsum, and root of the tongue. Deglutitive tongue movements in patients with a skeletal Class II relationship are different from those with a skeletal Class I relationship.
Asunto(s)
Deglución/fisiología , Imagen Eco-Planar/métodos , Imagen por Resonancia Cinemagnética/métodos , Maloclusión Clase II de Angle/fisiopatología , Lengua/fisiopatología , Adolescente , Cefalometría/métodos , Esófago/patología , Femenino , Humanos , Masculino , Maloclusión Clase I de Angle/fisiopatología , Mandíbula/patología , Maxilar/anomalías , Maxilar/patología , Movimiento , Paladar Duro/patología , Paladar Blando/patología , Prognatismo/fisiopatología , Estudios Prospectivos , Retrognatismo/fisiopatología , Lengua/patologíaRESUMEN
OBJECTIVE: The objective of this study was to evaluate whether administration of a diuretic agent in MR urography has an effect on renal length and to determine whether the increase in length can be used for the assessment of renal function. CONCLUSION: Renal length may change after diuretic injection, and these changes correlate with renal function.
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Diuréticos/farmacología , Riñón/efectos de los fármacos , Imagen por Resonancia Magnética/métodos , Renografía por Radioisótopo/métodos , Obstrucción Ureteral/diagnóstico , Adolescente , Niño , Preescolar , Constricción Patológica , Femenino , Humanos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador , Imagenología Tridimensional , Lactante , Pruebas de Función Renal , Masculino , Compuestos de Organotecnecio , Radiofármacos , Estudios Retrospectivos , Estadísticas no Paramétricas , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Pentetato de Tecnecio Tc 99m , Tiopronina , Obstrucción Ureteral/diagnóstico por imagenRESUMEN
The original article [1] contains errors in Table 1 in rows ktrans and Ve; the correct version of Table 1 can be viewed in this Correction article.
RESUMEN
The adult diffusely infiltrating low-grade gliomas (LGGs) are typically IDH mutant and slow-growing gliomas having moderately increased cellularity generally without mitosis, necrosis, and microvascular proliferation. Supra-total resection of LGG significantly increases the overall survival by delaying malignant transformation compared with a simple debulking so accurate MR diagnosis is crucial for treatment planning. Data from meta-analysis support the addition of diffusion and perfusion-weighted MR imaging and MR spectroscopy in the diagnosis of suspected LGG. Typically, LGG has lower cellularity (ADCmin), angiogenesis (rCBVmax), capillary permeability (Ktrans), and mitotic activity (Cho/Cr ratio) compared to high-grade glioma. The identification of 2-hydroxyglutarate by MR spectroscopy can reflect the IDH status of the tumor. The initial low ADCmin, high rCBVmax, and Ktrans values are consistent with the poor prognosis. The gradual increase in intratumoral Cho/Cr ratio and rCBVmax values are well correlated with tumor progression. Besides MR-based technical artifacts, which are minimized by the voxel-based assessment of data obtained by histogram analysis, the problems derived from the diversity and the analysis of imaging data should be solved by using artificial intelligence techniques. The quantitative multiparametric MR imaging of LGG can either improve the diagnostic accuracy of their differential diagnosis or assess their prognosis.
RESUMEN
Herpesviruses are one of the most common groups of pathogens causing central nervous system infections in humans. They mostly cause encephalitis, meningitis, or myelitis in immunocompetent and immunocompromised patients. Children, adults, and the elderly can all be affected. Although contrast-enhanced CT is more widely used for diagnosis, contrast-enhanced MR imaging combined with diffusion-weighted imaging is superior to CT in the detection of early changes and the real extent of the disease, and in assessing prognosis and monitoring response to antiviral treatment. More sophisticated techniques, such as MR spectroscopy and perfusion imaging, can aid in the differential diagnosis of herpesvirus infections from other tumoral, demyelinating, and ischemic processes.
Asunto(s)
Encefalitis Viral/diagnóstico , Infecciones por Herpesviridae/diagnóstico , Mielitis/diagnóstico , Encefalitis Viral/transmisión , Encefalitis Viral/virología , Infecciones por Herpesviridae/transmisión , Infecciones por Herpesviridae/virología , Humanos , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Mielitis/virología , Neurorradiografía , Tomografía Computarizada por Rayos XRESUMEN
Prolapse of the ureterocele and its presentation as a vulval mass is an extremely rare condition. There are no detailed imaging findings of such cases in the literature. We present voiding cystourethrography and MRI findings of a newborn girl with a ureterocele extending through the urethra.
Asunto(s)
Ureterocele/diagnóstico , Neoplasias de la Vulva/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Ureterocele/patología , Ureterocele/cirugía , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/cirugíaRESUMEN
OBJECTIVE: The aim of this study was to analyse the value of diffusion-weighted magnetic resonance imaging (DWI) to determine the liver parenchyma iron concentration in ß-thalassaemia major patients. METHODS: Abdominal magnetic resonance (MR) imaging, including gradient echo sequences and DWI sequences, was undertaken of 55 ß-thalassaemia major patients. The apparent diffusion coefficient (ADC) values of liver parenchyma were measured in seven regions at the level of the portal bifurcation and compared with liver iron concentration (LIC). Patients with normal and mild liver dry weight (LDW) results were classified as group 1, whereas patients with moderate and severe values were classified as group 2. RESULTS: There was a dramatic decrease in ADC values as the severity of LIC increased. The median ADC values were 1.6-1.9 × 10-3 mm2 /sec in group 1 and 0.6-0.9 × 10-3 mm2 /sec in group 2. A negative correlation was observed between ADC and the LDW values in both groups. The ADC and LIC correlation in each subgroup was statistically significant with asymptotic 95% confidence intervals of 0.820-0.997. CONCLUSION: Diffusion-weighted imaging is sensitive to tissue changes as a result of iron accumulation and may be used to predict liver iron overload in ß-thalassaemia major patients with a high sensitivity and specificity.
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Imagen de Difusión por Resonancia Magnética/métodos , Sobrecarga de Hierro/diagnóstico por imagen , Hígado/diagnóstico por imagen , Talasemia beta/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: We describe the magnetic resonance (MR) imaging characteristics of dysembryoplastic neuroepithelial tumors (DNT) and discuss their differential diagnosis. MATERIAL AND METHODS: Proton MR spectroscopy (TE 30 and 136 ms), diffusion-weighted and perfusion images were retrospectively evaluated in 22 patients with pathologically proven DNT (17 male and 5 female, mean age 18.7 years) and 14 control subjects (10 male and 4 female, mean age 16.9 years). The results from the DNT patients and from the control subjects were compared using an independent sample t-test and the degree of correlation was tested by Pearson's correlation. RESULTS: All DNTs were solitary and in a supratentorial cortical or subcortical location (ten temporal, eight frontal and four parietal). They had low-signal on T1-weighted images and high-signal on T2-weighted images without a prominent mass effect. Additionally a cystic appearance (six patients, 27.3%), cortical dysplasia (six patients, 27.3%) and contrast enhancement (four patients, 18.2%) were also noted. No significant differences were detected in NAA/Cho, NAA/Cr, NAA/Cho+Cr or Cho/Cr ratios between DNT and normal brain. DNTs had a significantly higher mI/Cr ratio and apparent diffusion coefficient (ADC) values and lower cerebral blood values than normal parenchyma (P < 0.001). ADC had the highest correlation with the diagnosis of DNT (r = 0.996) followed by relative cerebral blood volume (rCBV) (r = -0.883) and mI/Cr ratio (r = 0.663). CONCLUSION: Proton MR spectroscopy, diffusion-weighted and perfusion imaging characteristics of DNTs provide additional information to their MR imaging findings. The MR spectrum showing a slight increase in mI/Cr ratio, and higher ADC and lower rCBV values than normal parenchyma help to differentiate DNTs from other cortical tumors, which had higher rCBV and lower ADC values than DNTs.
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Imagen de Difusión por Resonancia Magnética , Imagen Eco-Planar/métodos , Metabolismo Energético/fisiología , Glioma/irrigación sanguínea , Glioma/diagnóstico , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Tumores Neuroectodérmicos Primitivos/irrigación sanguínea , Tumores Neuroectodérmicos Primitivos/diagnóstico , Lóbulo Parietal , Neoplasias Supratentoriales/irrigación sanguínea , Neoplasias Supratentoriales/diagnóstico , Lóbulo Temporal , Adolescente , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Colina/metabolismo , Creatina/metabolismo , Diagnóstico Diferencial , Femenino , Glioma/patología , Humanos , Inositol/metabolismo , Masculino , Malformaciones del Desarrollo Cortical/diagnóstico , Malformaciones del Desarrollo Cortical/patología , Neovascularización Patológica/diagnóstico , Neovascularización Patológica/patología , Tumores Neuroectodérmicos Primitivos/patología , Lóbulo Parietal/irrigación sanguínea , Lóbulo Parietal/patología , Fosfocreatina/metabolismo , Valores de Referencia , Flujo Sanguíneo Regional/fisiología , Estudios Retrospectivos , Neoplasias Supratentoriales/patología , Lóbulo Temporal/irrigación sanguínea , Lóbulo Temporal/patologíaRESUMEN
INTRODUCTION: The purpose of this study was to assess the flap reconstructed hind feet of patients with MRI who were traumatized by land-mine. MATERIALS AND METHODS: T1 and T2 weighted images were obtained in 7 patients, 12 months later the reconstruction of their hind feet by myocutaneous flaps after land-mine trauma. RESULTS: In all patients T2 signal intensities of the myocutaneous flaps were slightly high compared to normal undisturbed muscle. Slight vascular engorgement was noted in the vicinity of the flaps in all cases. There were ankle joint ankylose (n=1), tarsal coalition (n=3), sklerosis within the calcaneus (n=1), bone cortex irregularities (n=3), absence of calcaneus (n=4), deformity in talus and bone marrow edema (n=1), navicular edema (n=2), remodeling in the superior aspect of talus neck (n=2), absence of talus (n=2), talocalcaneal ankylose (n=1), small collection in the superior aspect of flap (n=1), drenage canules (n=1). CONCLUSION: In reconstructed hind feet by myocutaneus flaps done for land-mine traumas, MRI presents useful information by displaying detailed anatomy of the flaps, bones, joints, soft tissues and associated complications.
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Traumatismos de los Pies/diagnóstico , Traumatismos de los Pies/cirugía , Imagen por Resonancia Magnética , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/cirugía , Adulto , Humanos , Estudios Longitudinales , Masculino , Resultado del TratamientoRESUMEN
Pelvic masses, especially hydatid disease, rarely present with sciatica (1, 2). We present the computed tomography (CT) and the magnetic resonance imaging (MRI) findings of a 49-year-old female patient with presacral hydatid disease, who was evaluated for her sciatica. We also want to emphasize the importance of assessing the pelvis of patients with symptoms and clinical findings that are inconsistent and that cannot be satisfactorily explained by the spinal imaging findings.
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Equinococosis/diagnóstico , Imagen por Resonancia Magnética/métodos , Pelvis/diagnóstico por imagen , Pelvis/patología , Ciática/parasitología , Tomografía Computarizada por Rayos X/métodos , Animales , Antihelmínticos/administración & dosificación , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Equinococosis/complicaciones , Equinococosis/cirugía , Echinococcus/efectos de los fármacos , Femenino , Humanos , Plexo Lumbosacro/diagnóstico por imagen , Plexo Lumbosacro/parasitología , Plexo Lumbosacro/patología , Mebendazol/administración & dosificación , Persona de Mediana Edad , Dolor/etiología , Pelvis/cirugía , Intensificación de Imagen Radiográfica/métodos , Recurrencia , Ciática/cirugíaRESUMEN
Magnetic resonance imaging (MRI) has increasingly new applications in neuro-otology. The aim of this review was to summarize MRI applications in neuro- otology and make a correlation between neuro-otologic anatomy and MR images. Different MRI techniques have been described in the imaging of different neuro-otologic structures. In particular, we discuss the effectiveness, indications, and techniques of MRI in the demonstration of neuro-otologic tracts and their related pathologies. MRI should be the first choice imaging modality for the evaluation of retrocochlear pathologies.
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Imagen por Resonancia Magnética , Enfermedades del Nervio Vestibulococlear/patología , Nervio Vestibulococlear/patología , Pérdida Auditiva/patología , Humanos , Valor Predictivo de las Pruebas , Acúfeno/patología , Vértigo/patologíaRESUMEN
Recent studies have pointed out dysfunction and histopathological changes of the choroid plexuses (CPs) with aging. This paper reviews apparent diffusion coefficient (ADC) values of the CPs for age-related changes. All the brain MR images of the patients between January 2013 and June 2014 in our Radiology Department were retrospectively investigated. Patients with major cranial abnormalities (brain tumors, hyperacute or acute ischemia, developmental anomalies, hemorrhage, hydrocephaly) were excluded. Diffusion-weighted images were obtained at the parameter values of b = 1000 s/mm2 in the axial plane. The transverse diameters of the lateral ventricles (LVs) and ADC values of both CPs were measured. Brain MRIs of 202 individuals, 97 men (48%), 105 women (52%), were studied. There were statistically significant positive correlations between the ADC values of CP and patient ages. (Right CP: r = 0.623; p < 0.05. Left CP: r = 0.654; p < 0.05). There were positive correlations between LV diameters and age ( r = 0.624, p < 0.05 for the right LV; r = 0.621, p < 0.05 for the left LV). The ADC values of age groups significantly differed ( p < 0.05); the ≥61-year-old group was significantly higher compared to younger individuals. There is a progressive increase of water diffusivity in the CPs during aging. ADC values should be considered as a neuroimaging quantitative biomarker in normal aging-dementia syndromes.
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Plexo Coroideo/diagnóstico por imagen , Plexo Coroideo/patología , Imagen de Difusión por Resonancia Magnética/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Benign adrenal gland cysts (BACs) are rare lesions with a variable histological spectrum and may mimic not only each other but also malignant ones. We aimed to review imaging features of BACs which can be helpful in distinguishing each entity and determining the subsequent appropriate management.
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Enfermedades de las Glándulas Suprarrenales/diagnóstico , Quistes/diagnóstico , Diagnóstico por Imagen , Diagnóstico Diferencial , HumanosRESUMEN
The objective of this study was to investigate the initial effects of a tongue crib on tongue movements during deglutition by using real time balanced turbo field echo (B-TFE) Cine-MR imaging. A total of 21 patients were evaluated in this study. The open-bite group (OBG) consisted of 11 patients (seven girls, four boys) who had a mean age of 11.09 +/- 2.02 years and a mean overbite of -5.14 +/- 1.83 mm. These patients were evaluated initially (T1) and while wearing a tongue crib (T2). A total of 10 patients (five girls, five boys) with a mean age of 14.5 +/- 2.6 years and with a mean overbite of 1.6 +/- 0.5 mm served as controls (CG), and only initial records were obtained from these patients. T2 was compared with T1 and CG. T1 was also compared with CG. We evaluated deglutition during three stages matching oral (1), pharyngeal (2), and esophageal (3) stages. Our results indicated that the tongue's tip positioned more posteriorly when the crib was in place (T2) compared with both T1 and CG; the anterior portion of the tongue's dorsum was at a lower position in T2 compared with both T1 and CG at stage 3; the midportion of the tongue's dorsum was at a lower position in T2 than in T1 and CG at stages 1 and 2. To compensate for the posterior position of the tongue's tip (caused by the tongue crib), adaptive changes occurred in the anterior and midportions of the dorsum of the tongue.
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Deglución/fisiología , Imagen por Resonancia Cinemagnética , Diseño de Aparato Ortodóncico , Aparatos Ortodóncicos , Lengua/fisiopatología , Adaptación Fisiológica/fisiología , Adolescente , Niño , Esófago/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/fisiopatología , Maloclusión/terapia , Movimiento , Mordida Abierta/fisiopatología , Mordida Abierta/terapia , Paladar Blando/fisiopatología , Faringe/fisiopatología , Hábitos LingualesRESUMEN
BACKGROUND: Circular anastomotic staplers have been used in colorectal surgery for several years with low complication rates. We report here an extremely rare case of direct colovaginal anastomosis and rectovaginal fistula occurred by using a 31 end-to-end anastomosis stapler after reversal of Hartmann's Procedure. STUDY DESIGN: A 33-year-old woman with complaint of rectal bleeding had undergone low anterior resection and end colostomy for rectal adenocarcinoma in 1995. In spite of making recommendation for colostomy closure, she had postponed the operation until 2003 due to afraid of incontinence. After reversal of Hartmann's procedure achieved by using circular stapler and diverting ileostomy, she developed complaints of vaginal gas and minimal vaginal fecal discharge. RESULT: Endoscopic examination and imaging methods revealed a rectovaginal fistula with a blind Hartmann's pouch. After a certain verification of complexity of the case, a reoperation which comprises true intestinal anastomosis and repair of fistula was performed. Postoperative period was uneventful except an incisional infection, and ileostomy was closed subsequently. CONCLUSION: A rectovaginal fistula, though encountered rarely, must be taken into account in cases with suspicious complaints after using circular stapler for pelvic intestinal anastomosis. Careful placement of stapler in accurate direction has a great importance to avoid stapling related complications.
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Colostomía/efectos adversos , Fístula Rectovaginal/etiología , Suturas/efectos adversos , Adenocarcinoma/cirugía , Adulto , Anastomosis Quirúrgica/efectos adversos , Neoplasias del Colon/cirugía , Femenino , Humanos , Fístula Rectovaginal/diagnósticoRESUMEN
OBJECTIVE: The middle interhemispheric (MIH) variant of holoprosencephaly (HPE) is the incomplete separation of midline cerebral hemispheres with the absence of callosal body. We aimed to describe the additional knowledge of diffusion tensor imaging (DTI) over conventional MRI in the evaluation of patients with MIH variant of HPE. METHODS: Conventional MRI and DTI data of five patients were retrospectively evaluated. The parenchymal anomalies as well as changes at white matter tracts were systematically reviewed. RESULTS: Except the callosal body and central cingulum fibres, which were missing in all patients, all other major white matter tracts (superior and inferior longitudinal, superior and inferior fronto-occipital, subcallosal and uncinate fasciculi and anterior commissure) had a normal course, thickness and integrity on diffusion tensor images. The genial and splenial callosal fibres were altered and rarefied on tractography. All patients had a central ventricular notch extending into the non-cleaved heterotopic grey matter involving the body of the corpus callosum, which is very typical for the MIH variant of HPE. The remnant traversing white matter fibres above the non-cleaved heterotopic grey matter and incomplete partition of the interhemispheric fissure were also identified. No Probst bundles were detected. A single common ventricle without the septum pellucidum was noted in all patients. One patient had incomplete partition of the thalami, and two patients had abnormally oriented thalami without any prominent interthalamic connection. Vertically oriented hippocampi were detected in four out of five patients. Three patients had relatively flat and vertically oriented Sylvian fissures and in two patients, fissures were abnormally connected over the vertex. CONCLUSION: Additional DTI findings can not only clearly reveal the white matter alterations better than conventional MRI but also provide a better understanding of the aetiological changes that cause the MIH variant of HPE. ADVANCES IN KNOWLEDGE: DTI can provide a better analysis of cerebral white matter connectivity and promotes understanding of the underlying microstructural changes that occur in patients with the MIH variant of HPE.