Detection of cholesteatoma: High-resolution DWI using RS-EPI and parallel imaging at 3 tesla.

The purpose of this study is to evaluate the impact of RS-EPI-DWI in the detection of cholesteatoma and to compare with single-shot echo-planar DWI (SS-EPI-DWI). Diffusion-weighted and apparent diffusion-coefficient (ADC) images were obtained using RS-EPI and SS-EPI techniques in 30 patients. Presence of cholesteatoma (3 point scale), amount of artefacts (4 point scale), visibility (4 point scale), and ADC values of the lesions were assessed. The results of both techniques were compared with each other and gold-standard (GS) test results. Lesion visibility and presence of artefact scores of RS-EPI-DWI group were significantly different from those of the SS-EPI group. RS-EPI-DWI images had fewer artefacts and higher visibility scores. The sensitivity, specificity, negative/positive-predictive, and overall-agreement values of RS-EPI-DWI technique were 100%, 78%, 100%, 74%, and 87%; respectively. These values for SS-EPI-DWI technique were 91%, 60%, 88%, 67%, and 75%; respectively. Also, these values were higher on axial plane than coronal plane images for ADC measurements. Based on gold-standard test findings, agreement values were good (κ=0.74) for RS-EPI-DWI and moderate for SS-EP-DWI (κ=0.50) techniques (P<0.001 for both). The RS-EPI-DWI technique allows a higher spatial-resolution and this technique is less susceptible to artefacts when compared with SS-EPI technique.

Apparent diffusion coefficient measurement of ovarian stroma: A potential tool for the diagnosis of polycystic ovary syndrome.

PURPOSE: The purpose of this study was to assess the diagnostic value of measuring the apparent diffusion coefficient (ADC) of ovarian stroma in polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: This study was approved by the institutional review board and informed consent was obtained from each women. A total of 17 women (mean age, 22.2 years±5.1 [SD]; range, 16-33 years) with a diagnosis of PCOS according to the Androgen Excess and PCOS Society criteria and 18 healthy women (mean age, 22.8 years±5.2 [SD]; range, 16-31 years) who served as a control group were included in this prospective study. ADC values of the ovarian stroma during the early follicular phase were calculated by two observers in the two groups. Comparisons were performed using the Student t-test. RESULTS: The mean ADC value in woman with PCOS (1.29±0.27×10-3 mm2/s; range: 0.59×10-3 - 1.88×10-3 mm2/s) was significantly lower than that in the control group (1.48±0.17×10-3 mm2/s; range: 1.12×10-3 - 1.86×10-3 mm2/s) (P<0.001). The ADC cutoff value for the determination of PCOS with maximum accuracy was 1.38×10-3 mm2/s (AUC: 0.720; 95% CI: 0.597, 0.843), yielding 78% sensitivity and 62.9% specificity. CONCLUSION: ADC values of ovarian stroma are lower in patients with PCOS than in control subjects. ADC measurement of ovarian stroma in women with PCOS might help improve the diagnosis of PCOS.

The protective effect of L-carnitine against hippocampal damage due to experimental formaldehyde intoxication in rats.

We investigated the protective effects of L-carnitine on hippocampus tissue damage in rats during experimental formaldehyde (FA) intoxication. Male Wistar albino rats were assigned into four groups: (1) control (C), (2) formaldehyde (FA), (3) formaldehyde + 0.5 g/kg of L-carnitine (FA + 0.5 LC) (4) formaldehyde + 1 g/kg L-carnitine (FA + 1 LC). At the end of the 14 day trial period, animals were sacrificed by decapitation under anesthesia. The hippocampus tissue samples were extracted to measure MDA, GSH and SOD activity. Neuronal degeneration was assessed based on histopathological (hematoxylin and eosin) and immunohistochemical (anti-ubiquitin) examination. To detect oxidative stress, specimens were reacted with anti-Cu/Zn-SOD antibody. After administering L-carnitine with FA to the animals, the activities of SOD and GSH increased, but the levels of MDA decreased in hippocampus tissue. Neuronal degeneration was observed in the FA group. L-carnitine administration reduced neuronal degeneration and histological structure was similar to controls. After FA application, degenerated hippocampus neurons were stained with anti-ubiquitin and Cu/Zn-SOD antibodies; weakly positive staining was observed in L- carnitine-treated groups. L-carnitine may be useful for preventing oxidative damage in the hippocampus tissue due to formaldehyde intoxication.

Mean platelet volume in nasal polyps / Volumen medio de las plaquetas en los pólipos nasales

BACKGROUND: Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS: Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data ofpatients with nasal polyp were obtained at the time of diagnosis. RESULTS: There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS: Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPVvalues in patients with nasal polyps.

ANTECEDENTES: Muchos estudios en literatura señalan que las inflamaciones relacionadas con los pólipos nasales dependen en su mayoría de los eosinófilos y sus productos inflamatorios. Además de los eosinófilos, las plaquetas pueden jugar un papel en el desarrollo de los pólipos nasales. Las plaquetas participan en la hemostasia, la reparación de tejidos, y la inflamación. Sin embargo, que sepamos, la literatura existente no reporta estudios acerca de la asociación entre los parámetros de las plaquetas y los pólipos nasales. SUJETOS Y MÉTODOS: Cuarenta y tres pacientes con pólipos nasales y cuarenta y nueve controles sanos se inscribieron en el estudio, de forma retrospectiva. Se obtuvieron datos de laboratorio de los pacientes con pólipos nasales en el momento del diagnóstico. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre los dos grupos en términos de glóbulos blancos, hemoglobina, hematocritos y conteo de plaquetas. El valor medio de las plaquetas (MPV) del grupo con pólipos nasales fue significativamente menor que el del grupo control (p = 0. 025). El conteo medio de eosinófilos fue significativamente elevado en el grupo con pólipos nasales en comparación con el grupo control (p < 0.001). CONCLUSIONES: La reducción de MPVpuede ser un indicador para la formación de pólipos nasales. Se necesitan estudios adicionales con una mayor población de estudio para detectar la posible correlación entre los valores de MPV y el conteo de eosinófilos en pacientes con pólipos nasales.

Mean platelet volume in nasal polyps.

BACKGROUND: Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS: Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data of patients with nasal polyp were obtained at the time of diagnosis. RESULTS: There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS: Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPV values in patients with nasal polyps.

Oxidative stress and antioxidant enzyme activities in newborns with oesophageal atresia and their mothers.

OBJECTIVE: To measure the oxidant/antioxidant status of newborn babies with oesophageal atresia and their mothers, compared with healthy control subjects. METHODS: This case-control study included 40 participants: 10 newborns with oesophageal atresia and their mothers, and 10 healthy newborns and their mothers. Whole blood malondialdehyde (MDA) levels and the activities of antioxidant enzymes (catalase, carbonic anhydrase [CA], glucose-6-phosphate dehydrogenase [G-6-PD], and superoxide dismutase [SOD]) were measured. RESULTS: MDA levels and CA activity were significantly higher, and catalase, SOD and G-6-PD activities were significantly lower, in newborns with oesophageal atresia and their mothers than in healthy newborns and their mothers. Although CA activity was similar between the newborns and mothers in the patient group, it was significantly lower in newborns than in mothers in the healthy group. CONCLUSIONS: Increased lipid peroxidation might play an important role in the pathogenesis of oesophageal atresia. Impairment of the free radical/antioxidant balance may lead to increased free radical and decreased antioxidant levels in oesophageal atresia.

Spinal tanycytic ependymoma with diffusion restriction on MRI.

Tanycytic ependymoma is a rare spindle-cell variant of ependymoma derived from tanycytes. Primitive neuroectodermal tumors usually have diffusion restriction, whereas ependymomas do not. Here, we present a case of tanycytic ependymoma with diffusion restriction. As far we are aware, this is the first case of tanycytic ependymoma in the English literature with diffusion restriction.

Giant dilatations of virchow-robin spaces in the midbrain. MRI aspects and review of the literature.

Virchow-Robin spaces are lesions often seen in the brain parenchyma but their etiopathogenesis remains unsettled. Giant Virchow-Robin spaces placed in the midbrain are extremely rare. We describe three patients with a diagnosis of giant Virchow-Robin spaces in the midbrain, and their clinical and radiologic findings. We reviewed the literature in terms of the etiopathology, anatomic and radiologic appearance and differential diagnosis of the giant Virchow-Robin spaces. The diagno-stic role of the high Tesla magnetic resonance devices and new sequences techniques such as three dimensional isotropic acquisition and diffusion tensor imaging were also evaluated in this case series.

Macroscopic description of the coronary arteries in Swiss albino mice (Mus musculus).

A total of 25 (13 male, 12 female) adult, healthy Swiss albino mice were used to investigate the origin, course and anastomoses of coronary arteries. Coloured latex was injected into the aortic arch to enable these arteries to be clearly discerned. A. coronaria sinistra was larger than A. coronaria dextra. It was divided into a Ramus interventricularis paraconalis and a Ramus circumflexus sinister. However, in 2 specimens, the septal ramus, was observed to stem directly from the left coronary artery, and only 1 ventricular branch arose from the left circumflex. The collateral branches of the paraconal interventricular ramus had a larger diameter and more extensive distribution was observed in these specimens. The A. coronaria dextra was divided into a Ramus septalis and Ramus circumflexus dexter. The Ramus interventricularis subsinuosis was not detected in this study. The ventricular branches of the left coronary artery run intramyocardially whereas the branches of the right coronary artery course subendocardially.

Veins of the thoracic limb of the Van cat.

The drainage of the thoracic limb of the Van cat was performed by the superficial and deep vein systems. The superficial system was constituted by the cephalic vein and its branches. The deep vein system was constituted by the axillary vein and its branches. The two vein systems anastomosed with each other at various points along their courses. The cephalic vein emerged from the external jugular vein together with the superficial cervical vein. The axillary vein continued the subclavian vein. It ran caudoventrally and gave off the subscapular vein, at the level of the shoulder joint, then gave off two independent branches, which were the external thoracic veins. Then the rest of the vessel continued as the brachial vein. The thoracodorsal vein was formed by the communicate ramus vein which arose between the subscapular vein and the brachial vein. The cranial circumflex humeral vein arose double from the subscapular vein. One of them anastomosed with the deep brachial vein and the other one drained the biceps and the deep pectoral muscles. The cranial interosseous vein from the caudal aspects of the brachial vein and passed the interosseous space of the antebrachium then ran to the lateral aspect of the forearm. The caudal interosseous vein arose from the ulnar vein (in two specimens) and the median vein together with the ulnar vein (in two specimens) or independently from the median vein (in one specimen). Although many similarities were found in the veins of the thoracic limb of the Van cat as compared with the domestic cat, some significant differences were noted in the origin, course, anastomosing and ramification of veins of the thoracic limb.

Microvascular temporalis fascia transfer for penile girth enhancement.

The authors report a 44-year-old man with inadequate penile girth that caused psychological problems. Using microvascular temporalis fascia transfer, they achieved satisfactory penile girth enhancement based on reliable vascularity in a single stage.

Anxiety, depression, and nature of acne vulgaris in adolescents.

BACKGROUND: The reported prevalence of acne in adolescence is variable; improved treatment may have modified its prevalence and severity; acne has been related to psychiatric morbidity for many years. METHODS: Two thousand six hundred and fifty-seven high school students were examined, and adolescents with acne were interviewed about the subject of acne vulgaris. The severity of acne was graded using the Global Acne Grading System (GAGS). The Hospital Anxiety and Depression (HAD) scale was evaluated for one of every two subjects with acne (n = 308) and for the same number of sex-matched control subjects (n = 308) to determine the prevalence of depression and anxiety. RESULTS: Six hundred and fifteen of the subjects (23. 1%) were determined to have acne. Acne prevalence in girls and boys was 16.1% and 29.2%, respectively (P < 0.001). Two hundred and twenty-five (15.8%) of 1424 boys and only 109 (8.8%) of 1233 girls had moderate or severe/very severe acne (P < 0.001), but the GAGS scores in the groups of boys and girls with acne were not significantly different. The acne and control groups showed no significant differences in the HAD anxiety and depression subscale scores. The HAD anxiety subscale scores of girls were significantly higher than those of boys in the acne group. The severity of acne was not correlated with the HAD anxiety or depression subscale scores. CONCLUSIONS: Acne results in higher anxiety in adolescent girls. Although acne and moderate/severe acne are more common in adolescent boys, the severity of acne was found to be similar in boys and girls with acne. Adolescent girls are more vulnerable than boys to the negative psychological effects of acne.

Psychiatric disorders in patients attending a dermatology outpatient clinic.

BACKGROUND: Psychiatric comorbidity in patients with skin disorders has been reported. OBJECTIVE: To find out the prevalence of psychiatric disorders in dermatology outpatients and to investigate the factors that affect the psychiatric symptoms. METHODS: 256 patients attending our dermatology outpatient clinic completed a 12-item General Health Questionnaire (GHQ) following their dermatologic examination. A standardized personal interview was performed to establish a psychiatric diagnosis in patients sampled by using a stratified random sampling method. RESULTS: The prevalence of psychiatric disorders was found to be 33.4% in the study group. The mean of the total GHQ scores of the sample group (n = 256 patients) was 3.656. The duration of the dermatologic complaints, sex of the subjects, localization of the lesions, and dermatologic diagnosis did not affect the total GHQ scores of the patients. CONCLUSION: Psychiatric comorbidity in 33.4% of the dermatology outpatients indicates the need for considering emotional factors for an effective management of the cutaneous disorders.

Vesicouterine fistula (Youssef's syndrome): case report.

Vesicouterine fistula (Youssef's syndrome), a rare complication of cesarean section is presented. A 33-year-old female had vesicouterine fistula with symptoms of amenorrhoea and cyclic haematuria following cesarean section. The patient was treated by hysterectomy and the fistula tract was repaired.

Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers.

Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1%) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS > or = 17). The mean score of mHDRS was 7.57 +/- 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device.

Appraisal of self, social environment, and state authority as a possible mediator of posttraumatic stress disorder in tortured political activists.

This study examined appraisal of self and others, as measured by semantic differential ratings of Police, State, Society, Family, Friend, Myself as a Man/Woman, and Myself as a Political Person, in 55 tortured political activists in Turkey, 55 nontortured political activists, and 55 nontortured, politically noninvolved controls. There were no remarkable differences between tortured and nontortured political activists; both groups differed from controls in having a more negative appraisal of the police and the state and stronger perceptions of danger, mistrust, and injustice in relation to state authority. Lack of beliefs concerning a "benevolent state" may have protected the survivors from the traumatic effects of state-perpetrated torture. Further research into the possible protective role of belief systems in posttraumatic stress disorder is needed.

Is general anaesthesia necessary for URS in women?

A total of 65 women with ureteral stone who underwent ureteroscopy were divided randomly into two groups between April 1993 and March 1994. URS was performed under general anaesthesia in the first group (35 patients), and under local anaesthesia with sedation analgesia in the second group (30 patients). Only 2 patients of the second group did not tolerate the operation. The success rate was 88% in the first group and 83.3% in the second. There was no significant difference between the two groups. Since URS under local anaesthesia is time-saving, cost-effective, and highly tolerable in women, it is a good choice for ureteral stones.

Urothelial hyperplasia complicating use of metal stents in malignant ureteral obstruction.

Self-expandable metal stents (7 mm in diameter) combined with coaxial double-j stents were placed in 10 ureters in ten patients with malignant ureteral obstruction. After 2 and 3 months, when the double-j stents were removed in seven patients, six patients developed hydronephrosis and one patient tolerated removal of the double-j stent and had no signs of urinary obstruction until she died in the fifth month. A double-j stent was inserted again in six patients who developed hydronephrosis. Endoscopy performed during insertion of the double-j stents showed urothelial hyperplasia and incrustations which reduced the lumen of the metal stent. Their double-j stents were exchanged with new ones every 3 months. In the last three patients, double-j stents were not removed, but exchanged with new ones every 3 months. Endoscopy performed regularly during the exchange of the double-j stents in the follow-up of nine patients showed that urothelial hyperplasia, although mild, persisted until the sixth month in three patients. We conclude that urothelial hyperplasia and incrustations limit the use of metal stents in malignant ureteral obstruction. Metal stents, however, when used together with the coaxially placed double-j stents, contributed to the achievement of internal urinary drainage in this study. Since a metal stent provides a buttress for the previously obstructed segment of the ureter, the lumen, although decreased by hyperplasia and incrustations, is held open, which allows an easy exchange of the double-j stent. Regarding the high cost of metal stent, use of it with a coaxial double-j stent should be spared for the malignant ureteral obstructions when a previously placed double-j stent alone fails to achieve efficient drainage.

Factors related to long-term traumatic stress responses in survivors of torture in Turkey.

OBJECTIVE: To examine factors related to long-term psychological functioning in political ex-prisoners who had been subjected to systematic torture. DESIGN: The psychological status of 55 tortured political activists, 55 nontortured political activists, and 55 subjects with no history of torture or political activism was assessed using Structured Clinical Interview for DSM-III for psychiatric assessment, Semi-structured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD). Correlational and multiple regression analyses were used to assess the independent effects of precaptivity, captivity, and postcaptivity variables as predictors of long-term psychological status among the torture survivors. SETTING: Istanbul, Turkey. MAIN OUTCOME MEASURES: Number of lifetime and current PTSD symptoms, and scores on the Beck Depression Inventory, Hamilton Depression Rating, Hamilton Anxiety Scale, and State-Trait Anxiety Inventory. RESULTS: Effect of captivity experience on various life areas (eg, family and social, economic, and employment status) and other postcaptivity psychosocial stressors were associated with PTSD symptoms, anxiety, and depression. Perceived severity of torture was related to PTSD symptoms but not to anxiety or depression. Lack of social support predicted anxiety and depression but not PTSD. Family history of psychiatric illness correlated with higher scores on most measures. Impact of captivity experience on family was the strongest predictor of PTSD symptoms. CONCLUSIONS: These findings point to three types of stressors related to different aspects of psychopathology in survivors of torture: perceived severity of torture, secondary effects of captivity experience on various life areas, and general psychosocial stressors following captivity. Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.

Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey.

OBJECTIVE: The aim of the study was to investigate the long-term effects of torture in a group of former political prisoners. METHOD: The study was carried out in Istanbul, Turkey, where 55 Turkish political activists who had been tortured were compared with a closely matched group of 55 activists who had not been tortured. The Structured Clinical Interview for DSM-III-R, the Semistructured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD) were used. The tortured and the nontortured activists were similar in age, sex, marital and socioeconomic status, political ideology, political involvement, stressful life events other than torture, and other features. RESULTS: The torture survivors reported an average of 291 exposures to a mean of 23 forms of torture. The mean length of their imprisonment was 47 months. The survivors of torture had significantly more symptoms of PTSD and anxiety/depression than the nontortured comparison subjects, although their PTSD symptoms were only moderately severe and their general mood was normal. Despite the severity of their torture experiences, the survivors had only a moderate level of psychopathology. CONCLUSIONS: The results suggest that torture has long-term psychological effects independent of those related to uprooting, refugee status, and other traumatic life events in a politically repressive environment. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.