Morphometric assessment of the hip joint in children aged 2-13 years.

Our study aimed to evaluate the hip joints of healthy children aged 2-13 years morphometrically through radiographic images. Demographic characteristics of 300 healthy children in our study include an average age of 6.4 years old based on the 2-to-13-year-old bracket and sex classified to 133 girls and 167 boys. A total of 600 normal hips from these children were digitally measured based on Acetabular Index, ACM angle, MZ distance, Sharp angle, CE angle, Femoral Head Coverage Ratio, Cranial, and medial joint space (MJS). *p < 0.05; **p < 0.01 indicated a statistically significant difference. It was found that Acetabular Index, ACM angle, MZ distance, Sharp angle, Cranial, and MJSs decreased with age; Acetabular Depth value and CE angle increased with age; the CE angle differed between the sides (right-left) in the young teens period and in boys; and the cranial joint space (CJS) differed between the sides in girls. In addition, girls had higher values than boys in terms of Acetabular Index, ACM angle, Sharp angle, MZ distance, and Femoral Head Coverage Ratio; CE angle and MJS were higher in girls; and Acetabular Depth Value and CJS did not differ significantly between sexes. Obtaining the normal values will guide in the diagnosis and treatment of many clinical conditions including DDH and Legg-Calve-Perthes disease. It can also be used to compare the hips between healthy children and those diagnosed with Cerebral Palsy.

A reappraisal of pediatric thoracic surface anatomy.

Accurate knowledge of surface anatomy is essential for physical examination, invasive procedures, and anatomy education. Individual factors such as age make surface landmarks variable so accurate descriptions are needed. The aim of this study is to describe age-related surface landmarks for intrathoracic structures in children. A total of 156 thoracic computed tomography scans of children aged 0-18 years were categorized into six groups, and the associations between major intrathoracic structures and surface landmarks were analyzed. Sternal angle is an accurate surface landmark for the azygos vein-superior vena cava junction in all age groups. However, the aortic arch (except in the 0-1 year group), the bifurcation of the pulmonary trunk and the tracheal bifurcation in those aged 15-18 years were not within this plane. The left brachiocephalic vein was located behind the ipsilateral sternoclavicular joint except in the 1-3 years group, and the right was behind it in children older than 6 years. The apex of heart was at the 5th intercostal space level in the 0-1 and 12-18 years groups; however, it was higher in the other groups. The lower borders of the lungs were at the sixth costal cartilage level in the midclavicular line, eighth intercostal space level in the midaxillary line, and T12 adjacent to the vertebral column in the 15-18 years group; the lower borders were at higher levels in younger children. Defining the variations in surface anatomy by in vivo studies will increase its clinical and pedagogical value.

Arterial hemodynamics and its correlation with retinal microarchitecture in pseudoexfoliation glaucoma / Hemodinâmica arterial e sua correlação com a microarquitetura retiniana no glaucoma pseudoesfoliativo

ABSTRACT Purpose: The study aimed to investigate the correlation between arterial hemodynamics measured by color Doppler ultrasonography and retinal microarchitecture parameters determined by spectral-domain optical coherence tomography (SD-OCT) in pseudoexfoliation glaucoma. Methods: This prospective study included 82 participants. Peripapillary retinal nerve fiber layer, ganglion cell inner plexiform layer, and ganglion cell complex values were measured. Ophthalmic artery and central retinal artery flows were evaluated with color Doppler ultrasonography, and resistivity index values were calculated. Results: The study included 47 controls and 35 pseudoexfoliation glaucoma cases. In pseudoexfoliation glaucoma group, mean peripapillary retinal nerve fiber layer and ganglion cell complex thickness were statistically significantly lower in all quadrants compared to controls (p<0.001). Resistivity index values of the ophthalmic and central retinal arteries were significantly higher in pseudoexfoliation glaucoma group than in the controls (p<0.001 and r=0.684). Resistivity index values of the ophthalmic and central retinal arteries with ganglion cell complex thickness correlated significantly. On the other hand, no significant relationship for retinal nerve fiber layer thickness was identified. Conclusions: Structural changes (ganglion cell complex and ganglion cell inner plexiform layer) in patients with pseudoexfoliation glaucoma and early glaucomatous loss showed a significant correlation with changes in ocular vascular hemodynamics. In cases where systemic vascular resistance is increased, ganglion cell complex and ganglion cell inner plexiform layer may not exactly reflect glaucoma state. In such cases, thickness changes in the retinal nerve fiber layer may give more realistic results regarding glaucoma. We have seen that pseudoexfoliation glaucoma-induced structural deterioration and increased resistance in ocular hemodynamics correlated with ganglion cell complex, but not retinal nerve fiber layer.

RESUMO Objetivo: Investigar a correlação entre a hemodi­nâmica arterial, medida pela ultrassonografia com Doppler colorido, e os parâmetros de microarquitetura da retina, determinados pela tomografia de coerência óptica de domínio espectral (SD-OCT) no glaucoma pseudoexfoliativo. Métodos: Foram incluídos 82 participantes neste estudo prospectivo. Foram medidos os valores da camada de fibras nervosas da retina peripapilar, da camada plexiforme interna de células ganglionares e do complexo de células ganglionares. Os fluxos da artéria oftálmica e da artéria central da retina foram avaliados com ultrassonografia por Doppler colorida e foram calculados os valores do índice de resistividade. Resultados: Foram incluídos no estudo 47 casos de controle e 35 casos de glaucoma pseudoexfoliativo. No grupo com glaucoma pseudoexfoliativo, a média da camada de fibras nervosas da retina peripapilar e a espessura do complexo de células ganglionares foram menores em todos os quadrantes em comparação com os controles, com significância estatística (p<0,001). Os valores do índice de resistividade das artérias oftálmica e central da retina foram significativamente maiores no grupo com glaucoma pseudoexfoliativo que nos controles (p<0,001 e r=0,684). Ao se compararem os valores do índice de resistividade das artérias oftálmica e central da retina com a espessura do complexo de células ganglionares, foi encontrada uma correlação significativa entre elas. Por outro lado, não detectamos uma relação significativa para a espessura da camada de fibras nervosas da retina. Conclusões: Alterações estruturais (complexo de células ganglionares, camada plexiforme interna de células ganglionares) em pacientes com glaucoma pseudoexfoliativo com perda glaucomatosa precoce mostraram uma correlação significativa com alterações na hemodinâmica vascular ocular. Nos casos em que a resistência vascular sistêmica é aumentada, o complexo de células ganglionares e a camada plexiforme interna de células ganglionares podem não refletir exatamente o estado do glaucoma. Nesses casos, alterações na espessura da camada de fibras nervosas da retina podem dar resultados mais realistas em relação ao glaucoma. Observou-se uma correlação da deterioração estrutural induzida pelo glaucoma pseudoexfoliativo e do aumento da resistência na hemodinâmica ocular com o complexo de células ganglionares, mas não com a camada de fibras nervosas da retina.

Arterial hemodynamics and its correlation with retinal microarchitecture in pseudoexfoliation glaucoma.

PURPOSE: The study aimed to investigate the correlation between arterial hemodynamics measured by color Doppler ultrasonography and retinal microarchitecture parameters determined by spectral-domain optical coherence tomography (SD-OCT) in pseudoexfoliation glaucoma. METHODS: This prospective study included 82 participants. Peripapillary retinal nerve fiber layer, ganglion cell inner plexiform layer, and ganglion cell complex values were measured. Ophthalmic artery and central retinal artery flows were evaluated with color Doppler ultrasonography, and resistivity index values were calculated. RESULTS: The study included 47 controls and 35 pseudoexfoliation glaucoma cases. In pseudoexfoliation glaucoma group, mean peripapillary retinal nerve fiber layer and ganglion cell complex thickness were statistically significantly lower in all quadrants compared to controls (p<0.001). Resistivity index values of the ophthalmic and central retinal arteries were significantly higher in pseudoexfoliation glaucoma group than in the controls (p<0.001 and r=0.684). Resistivity index values of the ophthalmic and central retinal arteries with ganglion cell complex thickness correlated significantly. On the other hand, no significant relationship for retinal nerve fiber layer thickness was identified. CONCLUSIONS: Structural changes (ganglion cell complex and ganglion cell inner plexiform layer) in patients with pseudoexfoliation glaucoma and early glaucomatous loss showed a significant correlation with changes in ocular vascular hemodynamics. In cases where systemic vascular resistance is increased, ganglion cell complex and ganglion cell inner plexiform layer may not exactly reflect glaucoma state. In such cases, thickness changes in the retinal nerve fiber layer may give more realistic results regarding glaucoma. We have seen that pseudoexfoliation glaucoma-induced structural deterioration and increased resistance in ocular hemodynamics correlated with ganglion cell complex, but not retinal nerve fiber layer.

Correlation of Measurements From Doppler Ultrasound and Optical Coherence Tomography in Glaucoma.

OBJECTIVES: To relate the changes in ocular structure and hemodynamic response in primary open-angle glaucoma (POAG). METHODS: Patients with POAG (n = 46) and control subjects (n = 53) were recruited. Retinal nerve fiber layer and ganglion cell complex were evaluated using optical coherence tomography (OCT). Blood flow was characterized in ophthalmic artery (OA) and central retinal artery (CRA) using color Doppler ultrasonography (CDU), and resistivity index (RI) was calculated. Measurements from CDU and OCT were statistically correlated and the degree of the association was examined. Receiver operating characteristics was produced based on RI and optimal threshold was determined. RESULTS: In POAG patients, OCT revealed neuronal damage and CDU indicated increased resistance to arterial flow. Flow dynamics correlated negatively with the ocular tissue dimensions, sufficiently establishing an association between the ocular structure and its hemodynamic response. Based on the possibility of indirect POAG diagnosis with CDU, threshold 0.7 for RI of OA yielded 73.9% sensitivity and 77.4% specificity in distinguishing the cases of POAG from the controls. Threshold of 0.66 for RI of CRA, had higher specificity of 83%, but lower sensitivity of 52.1%. CONCLUSIONS: Ocular flow exhibits different characteristics in individuals with POAG than normal. The changes associated with the underlying neuronal structure, suggesting the possibility of a potential new diagnostic biomarker for POAG. This justifies further studies with a larger cohort, examining the ocular flow with CDU in POAG and comparing it against OCT findings for establishing the power of CDU in differential diagnosis or glaucoma progression.

A reappraisal of pediatric abdominal surface anatomy.

Surface anatomy is fundamental to clinical and surgical practices. As the surface anatomy varies with age, the purpose of this study is to provide age-standardized surface markings for the abdomen in children. A total of 155 abdominal computed tomography scans of healthy children aged 0-18 years were categorized into six groups, and the surface anatomy of the major vascular structures, solid viscera, and anatomical planes in the abdomen was analyzed. The vertebral levels of the celiac trunk, superior mesenteric artery, and hepatic portal vein formation were higher in the youngest age group, whereas the levels of the inferior mesenteric artery, formation of the inferior vena cava, and renal arteries did not differ with age. The right kidney lay between T12 and L3 and the left at T11-L3; however, both kidneys were in lower positions in younger children. The spleen was most commonly located between the 8th and 11th ribs except in toddlers. In all age groups, the hepatic portal vein formation was within the transpyloric plane and the aortic bifurcation was above the supracristal plane. In vivo reassessment of the surface anatomy enables the substantial variability of surface landmarks to be highlighted. This study demonstrates that taking account of age-related variations will increase the accuracy and therefore the clinical relevance of surface anatomy.

Correlation of optical coherence tomography and Doppler ultrasonography findings in pseudoexfoliation syndrome.

PURPOSE: We aimed to investigate the correlation between the color Doppler imaging (CDI) results and parameters determined by spectral domain optical coherence tomography (SD-OCT) in cases with pseudoexfoliation syndrome (XFS). METHODS: 99 participants were included in this prospective study. Retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), optic nerve head (ONH) measurements were recorded. Perfusions of the ophthalmic artery (OA) and central retinal artery (CRA) were determined and resistivity indices (RI) were calculated. RESULTS: No statistically significant differences were determined between the groups regarding the RNFL and ONH parameters. Only the minimum GCC thickness value was determined to be reduced in XFS group (n = 49) when compared to the controls (n = 50) (p = 0.018). The OA-RI and CRA-RI values of XFS group were significantly higher than the control group (p < 0.001 and p = 0.001). In XFSs, negative correlations were present between OA-RI and the minimum, average, inferior and inferotemporal regions of GCC thickness (r = - 0.448 p = 0.001, r = - 0.275 p = 0.040, r = - 0.295 p = 0.027, r = - 0.304 p = 0.024, respectively), and also between CRA-RI and minimum GCC values (r = - 0.317, p = 0.017). While a significant relationship was present between age and OA-RI and CRA-RI values in controls, no such correlation was present in XFSs. CONCLUSIONS: The vascular resistance increased with age in controls, whereas it was independent of age in XFS group. In XFSs, RIs correlated significantly with certain GCC values, but not with RNFL and ONH parameters. It would be beneficial to follow the XFS with CDI as it provides supportive parameters to GCC in order to recognize early changes in XFS.

The relationship between frailty and serum alpha klotho levels in geriatric patients.

BACKGROUND: Frailty is a medical syndrome resulting in loss of endurance, strength and physiological function. There is insufficient data to understand the process of frailty formation at the gene level, however one of the product of Klotho gene known as an anti-aging gene with many functions that prolong lifespan is alpha klotho protein. We aimed to investigate the relationship between frailty and the serum alpha klotho protein levels. METHODS: In this cross-sectional analysis, there were 89 patients aged 65 years old and older, 45 of whom were frail and 44 of whom were not frail, were included in the study. Within the scope of the study, a sociodemographic and clinical information form, the Turkish version of the FRAIL scale and a comprehensive geriatric assessment were evaluated. In addition to routine laboratory tests, plasma alpha klotho protein levels were measured. RESULTS: The mean alpha klotho protein levels of the patients were 0.76 ± 1.01 ng/ml in the control group and 0.54 ± 0.61 ng/ml in the frail group, however, there was no statistically significant difference between the two groups (p = 0.286). C-reactive protein (CRP) levels were significantly higher and hemoglobin (Hb) levels were significantly lower in the frail patients compared to the control group (p < 0.05). It was observed that alpha klotho protein level was inversly correlated with increased CRP levels but association was weak (p = 0.022, R: -0.245). Hb levels (p = 0.018, R: 0.250) was weakly correlated with alpha klotho protein level. CONCLUSION: No significant relationship was found between frailty and alpha klotho protein levels in the geriatric patients. Further comprehensive studies are needed to explore this subject.

Sonoelastic response of median nerve to rehabilitation in carpal tunnel syndrome.

Aim of the study: To evaluate the sonoelastic response of the median nerve in patients with carpal tunnel syndrome following conservative rehabilitation with splint plus exercise regimens. Materials and methods: A total of thirty-five patients diagnosed with mild carpal tunnel syndrome and treated with splint plus exercise therapy; hand resting splint all day for 3 weeks and then only at nights along with nerve gliding exercises in 10 repetitions 3 times a day. The median nerve was evaluated clinically prior to the treatment and at week 6 of therapy using physical examination, electrodiagnostic neurophysiology tests and radiological imaging; Boston Scores, electromyogram, ultrasonography and sonoelastography. Results: Following the 6-week treatment protocol on 35 subjects with mild carpal tunnel syndrome, sonoelastography showed significantly softer median nerve, while the traditional parameters based on Boston Scores and cross-sectional area based on ultrasonography remained nearly unresponsive. Such early indication of biomechanical changes in the nerve may be of clinical importance if it can offer a prognostic value of the applied treatment, while tissue softening suggests the alleviation of nerve compression. Conclusions: Sonoelasticity of the median nerve can serve as a reliable marker for assessing therapeutic changes in median nerve stiffness and potentially the outcome early on in mild carpal tunnel syndrome.Aim of the study: To evaluate the sonoelastic response of the median nerve in patients with carpal tunnel syndrome following conservative rehabilitation with splint plus exercise regimens. Materials and methods: A total of thirty-five patients diagnosed with mild carpal tunnel syndrome and treated with splint plus exercise therapy; hand resting splint all day for 3 weeks and then only at nights along with nerve gliding exercises in 10 repetitions 3 times a day. The median nerve was evaluated clinically prior to the treatment and at week 6 of therapy using physical examination, electrodiagnostic neurophysiology tests and radiological imaging; Boston Scores, electromyogram, ultrasonography and sonoelastography. Results: Following the 6-week treatment protocol on 35 subjects with mild carpal tunnel syndrome, sonoelastography showed significantly softer median nerve, while the traditional parameters based on Boston Scores and cross-sectional area based on ultrasonography remained nearly unresponsive. Such early indication of biomechanical changes in the nerve may be of clinical importance if it can offer a prognostic value of the applied treatment, while tissue softening suggests the alleviation of nerve compression. Conclusions: Sonoelasticity of the median nerve can serve as a reliable marker for assessing therapeutic changes in median nerve stiffness and potentially the outcome early on in mild carpal tunnel syndrome.

The Relationship Between MRI Findings and Molecular Subtypes in Women With Breast Cancer.

OBJECTIVE: To determine the preoperative MRI findings of patients with breast cancer according to molecular subtypes. MATERIALS AND METHODS: MRI findings of women diagnosed with breast cancer in our department between January 2013 and June 2017 who had preoperative breast MRI examinations were evaluated and histopathological findings were recorded retrospectively. The findings were classified according to the BI-RADS MRI classification by three radiologists. Correlations of MRI findings with the molecular subtypes were evaluated using Chi-square and t-tests. RESULTS: Among 234 lesions in a total of 224 cases diagnosed with breast cancer, subtypes of breast cancer as following: Luminal (162 cases, 69%), triple negative (39 cases, 17%) and HER2 positive (33 cases, 14%), respectively. Lesions of patients with luminal, triple negative and HER2 positive invasive ductal cancer were round or lobular in shape (9.9%, 42.9%, 20.7%), had high/very high intratumoral T2 signal intensity (24.8%, 54.2%, 31%) and rim enhancement pattern (9.2%, 51.4%, 24.1%), respectively. The difference between the triple negative cases and the other subtypes was statistically significant (p < 0.05). CONCLUSION: One of the most important factors that determine the prognosis and treatment in breast cancer is the molecular subtype of the tumor. Morphologic findings of MRI can be a useful tool for differentiating triple negative breast cancer from other subtypes.

Is Thyroid Imaging Reporting and Data System Useful as an Adult Ultrasonographic Malignancy Risk Stratification Method in Pediatric Thyroid Nodules?

BACKGROUND: Data on thyroid imaging reporting and data system (TI-RADS) generally belong to studies performed in adults. Therefore, we aimed to evaluate the performance and utility of TI-RADS in the pediatric group. MATERIALS AND METHODS: From January 2015 to 2018, 108 nodules were evaluated in 1028 thyroid ultrasound examinations. Images were retrospectively evaluated by two radiologists with 3 and 7 years of pediatric radiology experience, according to TI-RADS classification. Morphological findings of the detected nodules and their histopathological results were recorded. Histopathological findings and at least 12 months of follow-up imaging were taken as reference. RESULTS: Seventy-one patients were female (67%). The mean age was 11.4 ± 4.7, and the mean nodule size was 7.4 ± 8.3 mm. According to the histopathological assessment and at least 12 months' follow-up with clinical and sonographic stability 100 (95.2%) of the nodules were benign and 5 (4.8%) were malignant. Two nodules, nondiagnostic cytology and 1 nodule were found to be suspicious for malignancy. All malignant nodules were in the TI-RADS 5 category. The majority of benign nodules (79%) were found in low TI-RADS categories. About 80% of the malignant nodules were very hypoechoic and taller than wide in shape, also all malignant nodules had microcalcifications (P = 0.000). The sensitivity of TI-RADS was 100%, specificity was 78.8%, positive predictive value (PPV) was 19.2%, and negative predictive value (NPV) was 100%. CONCLUSION: According to our study, TI-RADS system can be used to evaluate thyroid nodules in pediatric patients similar to adults.

Pregnancy-associated breast cancer: A review of 47 women.

PURPOSE: Pregnancy-associated breast cancer (PABC) is a rare disease. However, its expected incidence tends to be increased because of delayed maternal age. The purpose of this study was to describe the clinical, radiological, and histopathological characteristics of PABC cases diagnosed in our center. METHODS: The clinical-radiological findings and histopathological characteristics of patients diagnosed and treated with PABC at our institution between January 2011 and January 2017 were retrospectively evaluated. RESULTS: Mammography and ultrasonography were performed in all patients. MRI examination was performed in 18 patients. Nine (19.1%) out of 47 patients were diagnosed with breast cancer during pregnancy, and 38 (80.9%) were in their first year after delivery. The most frequent finding (95.7%) during imaging was one or more masses. Mammography-detected pure or accompanying microcalcifications were found in 12 (25.5%) patients. MRI detected additional multifocal and multicentric disease in 14 (29.8%) patients and contralateral cancer in one (2.1%) patient. CONCLUSIONS: Pregnancy-related breast cancer tends to be diagnosed in an advanced stage with poor prognosis. Any breast abnormalities observed in this period should alert clinicians, and a meticulous radiological evaluation is mandatory. The early diagnosis of this disease would increase the chances of successful treatment.

The incidence of sinus crista galli in children and adults: a computerized tomography study / La incidencia del sinus crista galli en niños y adultos: un estudio de tomografía computarizada

The pneumatization area in the crista galli region of the ethmoid bone can be called Sinus Crista Galli (SCG). The authors would like to recommend the terminology as sinus crista galli for pneumatized crista galli. Our aims in this study are to determine SCG on three dimensional Computerized Tomography (CT) images, to investigate its frequency, dimension and to emphasize their clinical significance in children and adults. A total of 360 adult images (160 female, 200 male) and 68(43 female, 25 male) pediatric images were examined. The presence SCG was recorded with axial and coronal paranasal sinus CT images. The height, width, anterposterior diameter of the sinus was measured. All the data we obtained from this study were analyzed using the SPSS 18.0 program. Descriptive statistics are shown as mean ± Sdt. Sinus crista galli was found in 17 examined images of the 360 (4.72 %) in adult group. Chronic pansinusitis was detected in 7 of 17 cases. Frontal sinusitis findings were detected in 7 cases. Sinusitis was not observed in 3 cases. The incidence of SCG was found in 4 pediatric images out of 68 (5.88 %). In 1 out of 4 cases, infection was detected in SCG. We did not observe SCG in the pediatric group with 0-7 years of age. Sinus crista galli was found at low rates in adult and pediatric age group. However; relationship was found between these variation and chronic rhinosinusitis. Additionally, detection of SCG in paranasal sinus CT can be provided better results and reduce complications in anterior cranial fossa surgery.

El área de neumatización en la crista galli del etmoides se puede denominar sinus crista galli (SCG). Los autores recomiendan incluir en la terminología anatómica el término sinus crista galli para la crista galli neumatizada. Los objetivos del estudio fueron determinar la SCG en imágenes tridimensionales de tomografía computarizada (TC), investigar su frecuencia, dimensión y enfatizar su importancia clínica en niños y adultos. Se examinaron un total de 360 imágenes de adultos (160 mujeres, 200 hombres) y 68 (43 mujeres, 25 hombres) en imágenes pediátricas. La presencia de SCG se registró con imágenes de tomografía axial y axial del seno paranasal. Se midió la altura, anchura y diámetro anteroposterior del seno del proceso crista galli. Todos los datos obtenidos se analizaron mediante el programa SPSS 18.0. Las estadísticas descriptivas se muestran como media ± DS. El seno crista galli se encontró en 17/360 (4,72 %) de las imágenes examinadas en el grupo de adultos. Se detectó pansinusitis crónica en 7 de 17 casos. Se detectaron hallazgos de sinusitis frontal en 7 casos. Sinusitis no se observó en 3 casos. La incidencia de SCG se encontró en 4 imágenes pediátricas de 68 (5,88 %). En 1 de cada 4 casos, se detectó infección en SCG. No observamos SCG en el grupo pediátrico con 0-7 años de edad. El seno crista galli se encontró en bajas tasas en adultos y en niños. Sin embargo, se encontró relación entre estas variaciones y la rinosinusitis crónica. Además, la detección de SCG en la tomografía computarizada del seno paranasal puede proporcionar mejores resultados y reducir las complicaciones en la cirugía de la fosa craneal anterior.

The Role of Real-Time Elastography in the Differential Diagnosis of Salivary Gland Tumors.

OBJECTIVES: The aim of the study was to scrutinize the value of qualitative elastography in the diagnosis of salivary gland masses. METHODS: Sixty patients were enrolled in this prospective study. Patients aged between 1 and 91 years (mean age, 48.8 ± 20.48) with a salivary gland mass were studied with real-time elastography. All patients were examined by 1 examiner, blinded to all relevant data. On elastography, masses were scored into 4 types according to their stiffness compared to normal tissue. Scores of 3 and 4 were accepted as signs of malignancy. Sensitivity, specificity, and positive and negative predictive value were calculated for elastography in verifying malignancy. RESULTS: Forty-two percent of the masses were located in the parotid, and the rest in submandibular gland. The diameter of the lesions varied between 12 and 60 mm (mean, 24.36 ± 11.98 mm). Forty-four masses were benign (73%), and among them the majority were inflammatory lesions (31 of 60; 51.7%). There were 16 malignant lesions (27%). On elastography, not only all malignant lesions but 15 benign lesions were scored as 3 to 4. All masses scored as 1 to 2 were benign. Sensitivity was 100%; specificity, 66%; positive predictive value, 52%; and negative predictive value, 100%. When only Score 4 lesions were accepted as malignant, these values became 75%, 77%, 55%, and 90%, respectively. CONCLUSIONS: Elastography alone cannot be used to discriminate malignant from benign in the evaluation of salivary gland lesions. However, with its high negative predictive value, it may be used as an adjunct tool to increase the diagnostic value of ultrasonography.

Problem-solving breast MRI: useful or a source of new problems?

PURPOSE: We aimed to evaluate the findings and results from breast magnetic resonance imaging (MRI) examinations performed for problem-solving purposes due to inconclusive conventional imaging findings. METHODS: Imaging findings, biopsy and follow-up results were retrospectively evaluated for breast MRI performed for problem-solving purposes at our department between January 2011 and December 2016 for cases whose mammography, tomosynthesis, or ultrasonography findings were inconclusive. RESULTS: Lesions were identified in 414 of 986 problem-solving MRI examinations, and 13.3% of these lesions were diagnosed as malignant. A total of 124 lesions were additionally found by MRI, and 9.7% of these lesions were diagnosed as malignant. MRI produced false-negative results in four cases. In cases whose conventional imaging methods yielded indefinite results, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 96.3%, 83%, 99.3%, and 46.5%, respectively. For the additional lesions identified, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 91.7%, 69%, 98.7%, and 24%, respectively. CONCLUSION: Breast MRI is a reliable problem-solving method for excluding malignancy that cannot be confirmed by conventional imaging. In such cases, additional findings from MRI may help identify new cancers that cannot be detected with conventional methods. However, it has moderately low specificity which may cause unnecessary biopsies, follow-ups, and anxiety to patients.

The role of tomosynthesis in intraoperative specimen evaluation.

To investigate the contribution of breast tomosynthesis to intraoperative specimen evaluation in subjects with breast cancer. Approval was obtained from the hospital ethics committee. Specimen mammography, tomosynthesis, and, if available, ultrasonography images were retrospectively assessed for 208 women who had undergone conservative surgery at our hospital between January 2013 and April 2016 after being diagnosed with breast cancer. The success of mammography, tomosynthesis, and ultrasonography in lesion detection and characterization was evaluated. Of 208 lesions, 142 (68.3%) and 198 (95.2%) were detected by mammography and tomosynthesis, respectively. All lesions were detected in 150 subjects undergoing ultrasonography (124 dense breasts, 26 fatty breasts). In 84 women who had fatty breasts, all lesions were detected both by mammography and by tomosynthesis. In 124 women with dense breasts, lesions were detected by mammography in 59 (48%) and in 114 (92%) by tomosynthesis. The success of tomosynthesis in lesion detection was found to be markedly higher than mammography (P = .00). In conclusion, tomosynthesis contributed to mammography in specimen evaluation in a total of 101 subjects. The success of tomosynthesis in lesion detection and characterization during intraoperative specimen evaluation is higher than mammography. In daily practice, ultrasonography is performed for lesions which cannot be evaluated by specimen mammography due to dense parenchymal pattern. Tomosynthesis may reduce the need for and the time and workforce allocated to specimen ultrasonography in an important group of subjects.

Grueneberg Glomeruli in the Olfactory Bulb are Activated by Odorants and Cool Temperature.

Neurons of the Grueneberg ganglion respond to cool temperatures as well as to distinct odorants and extend axonal processes to the olfactory bulb of the brain. Analyses of transgenic mice, in which Grueneberg ganglion neurons and their axons are labeled, revealed that these axons innervated nine distinct glomeruli distributed in a characteristic topographical pattern in dorsal, lateral, ventral, and medial regions of rather posterior areas in the bulb. To assess activation of these glomeruli (hereinafter designated as Grueneberg glomeruli) upon stimulation of Grueneberg ganglion neurons, mice were exposed to the odorant 2,3-dimethylpyrazine (2,3-DMP) and the expression of the activity-dependent marker c-Fos in juxtaglomerular cells of the relevant glomeruli was monitored. It was found that all of these glomeruli were activated, irrespective of their localization in the bulb. To verify that the activation of juxtaglomerular cells in Grueneberg glomeruli was indeed based on stimulation of Grueneberg ganglion neurons, the 2,3-DMP-induced responses in these glomeruli were investigated in mice lacking the cyclic nucleotide-gated channel CNGA3 which is critical for chemo- and thermosensory signal transduction in Grueneberg ganglion neurons. This approach revealed that elimination of CNGA3 led to a reduction of the odorant-induced activity in Grueneberg glomeruli, indicating that the activation of these glomeruli is based on a preceding stimulation of the Grueneberg ganglion. Analyzing whether Grueneberg glomeruli in the bulb might also process thermosensory information, it was found that upon exposure to coolness, Grueneberg glomeruli were activated. Investigating mice lacking CNGA3, the activation of these glomeruli by cool temperatures was attenuated.

Rarely Seen Nasal Congenital Problems Causing Neonatal Upper Respiratory Obstruction: A Case Series.

Since newborns are obligatory nasal breathers, upper respiratory tract problems may sometimes be life threatening. The most common pathology causing dyspnea and stridor in newborns is laryngomalacia. Nasal cavity pathologies that risk the neonatal airway are more rarely met. These anomalies may be seen either as solitary anomalies or as a part of a syndrome. While choanal atresia is one of the best-known nasal cavity anomalies, choanal stenosis, congenital nasal mid-line masses, congenital nasal pyriform aperture stenosis, and nasal tip anomalies are more rarely seen structural pathologies. Choanal atresia may be present either as an isolated congenital anomaly or as a part of CHARGE syndrome. Some rare chromosome anomalies may also cause significant problems during nasal respiration in newborns. With this study, we presented a case series of newborns with pathologies that affected nasal respiration. Although the diagnosis and treatment of choanal atresia and congenital dacryocystocele are well known, the information on the diagnosis and treatment of the other two uncommon cases are limited. With this study, we aimed to contribute to the literature by presenting our approach in six cases having congenital pathologies that cause nasal respiratory obstruction.