Morphometric evaluation of cerebellar lobules in individuals with unilateral vertebral artery hypoplasia.

PURPOSE: Vertebral arteries (VAs) provide blood circulation to the posterior fossa in general and are the main blood supply of the posterior fossa structures of the brain. Our aim in this study is to analyze the segmental volumetric values of cerebellar structures with the voxel-based volumetric analysis system in individuals with unilateral vertebral artery hypoplasia. METHODS: In this retrospective study, segmental volumetric values/percentile ratios of cerebellar lobules were calculated using 3D fast spoiled gradient recall acquisition in steady-state (3D T1 FSPGR) MRI sequence images of the brain in individuals with unilateral vertebral artery hypoplasia (VAH) and in those without bilateral VAH and any symptoms of vertebrobasilar insufficiency as the control group was evaluated in volBrain ( http://volbrain.upv.es/ ). RESULTS: The VAH group consisted of 50 (19 males/31 females) and the control group had 50 (21 males/29 females) individuals. The cerebellar lobule III, IV, VIIIA and X total volumes and the cerebellar lobule I-II, III, IV, VIIIA and X gray matter volumes were lower in the hypoplastic side than the non-hypoplastic cases and also than the contralateral side of the hypoplastic cases in the VAH group. In addition, it was found that that lobules IV and V had lower cortical thickness and lobules I-II had a higher coverage rate in the intracranial cavity in the hypoplastic side than the non-hypoplastic cases and also than the contralateral side of the hypoplastic cases (p < 0.05). CONCLUSION: In this study, it was found that cerebellar lobule III, IV, VIIIA, X total volumes and cerebellar lobule I-II, III, IV, VIIIA, X gray matter volumes in addition to lobule IV, V cortical thicknesses were low in individuals with unilateral VAH. Being aware of these variations and taking them into account during future volumetric studies on the cerebellum are very important.

Decreased frontal and orbital volumes and increased cerebellar volumes in patients with anosmia Of Unknown origin: A subtle connection?

PURPOSE: Neuroimaging studies have shown that anosmia is accompanied by a decreased olfactory bulb volume, yet little is known about alterations in cerebral and cerebellar lobule volumes. The purpose of this study was to investigate structural brain alterations in anosmic patients. METHODS: Sixteen anosmic patients (mean age 42.62 ± 16.57 years; 6 women and 10 men) and 16 healthy controls (mean age 43.37 ± 18.98 years; 9 women and 7 men) were included in this retrospective study. All subjects who underwent magnetic resonance imaging scans were analyzed using VolBrain and voxel-based morphometry after olfactory testing. RESULTS: Despite being statistically insignificant, analysis using VBM revealed greater gray matter (GM) and white matter in the anosmia group compared to the healthy subjects. However, decreased GM (p < 0.001) and increased cerebellar (p = 0.046) volumes were observed in the anosmic patients. CONCLUSIONS: The study revealed structural brain alterations in specific areas beyond the olfactory bulb. Our results indicate that the cerebellum may play an exceptional role in the olfactory process and that this will be worth evaluating with further dynamic neuroimaging studies.

Hypovolemic shock due to giant ovarian tumor rupture after minor trauma: A case report.

Rupture of gynecologic tumors secondary to trauma rarely occurs. Rupture can lead to acute abdominal pain due to hemorrhage from the ruptured area and organs; rupture can also lead to peritonitis, depending on the size of the tumor. We describe the case of giant epithelial ovarian tumor rupture exhibiting due to minor trauma and the development of hypovolemic shock. A 69-year-old female patient was admitted to the emergency room with complaints of acute abdominal pain and subsequent clouding of consciousness after falling down while walking. Emergency abdominal computed tomography scan revealed widespread hemorrhagic free fluid in the abdominal cavity and a mass measuring 27.5 cm × 21 cm × 15 cm, extending from the right quadrant of the abdomen to the left. The patient underwent an emergency operation due to hypovolemic shock. During surgery, a totally ruptured mass lesion arising from the right ovary was seen; the mass contained cystic components and measured approximately 30 cm × 20 cm × 15 cm. Hemostasis was achieved in the bleeding areas, and the right ovarian mass was totally resected. The patient was discharged as cured on the 6th post-operative day. Gynecologic tumor rupture due to trauma is a rare event. However, it is a clinical condition that should be kept in mind regardless of the type of trauma. This is especially true in patients who experienced trauma and were radiologically found to have intra-abdominal hemorrhage with normal-appearing solid organs, such as liver and spleen, that frequently cause bleeding.

Recurrent stump appendicitis.

Acute appendicitis is one of the most common reasons for abdominal surgery. Stump appendicitis, one of the rare complications of appendicitis surgery, is an inflammation that develops in the remaining part of the appendix following surgery and occurs at a rate of 1/50.000 in cases with appendectomy. Although patients manifest the same findings as those with acute appendicitis on physical examination and laboratory tests, the history of previous appendectomy may cause delays in diagnosis.. Complications such as perforation and peritonitis can develop if an early diagnosis cannot be made. In this article, we present the first case of recurrent stump appendicitis reported in the literature as far as we are aware.

The effect of intracerebral structure volumes on idiopathic intracranial hypertension.

BACKGROUND: This aim of this study was to assess the effect of idiopathic intracranial hypertension (IIH) in the development of intracranial hypertension by measuring patients' cerebrospinal fluid (CSF), brain, and segment volumes. IIH is a disease of unknown cause characterized by chronic CSF pressure elevation and papillary edema. Under the Monro-Kellie doctrine, efforts have been made to explain the disease through an increase in the volumes of one or two of brain, blood or CSF in the intracranial cavity, although these have not been completely successful. METHODS: Twelve IIH patients diagnosed based on the modified Dandy criteria and 15 age- and sex-compatible healthy controls were included in the study. Cases' 3D T1 sequence images were evaluated using the voxel-based volumetric analysis system (volBrain). Intracranial cavity extraction, macrostructures, and subcortical structure volumes were measured and compared. RESULTS: No statistically significant differences were observed between control cases' and IIH patients' CSF, cerebrum, cerebellum, brainstem, and subcortical structure volumes. CONCLUSION: IIH arises from a chronic cause that does not impair the volumetric balance between structures inside the intracerebral cavity.

Morphometric evaluation of cerebellar structures in late monocular blindness.

BACKGROUND: Only a few studies have investigated structural and functional changes in monocular blind individuals. Our aim in this study was to segmentally investigate the cerebellar structures of subjects with late-onset monocular blindness (LMB) using a Voxel-based volumetric analysis system. METHODS: The segmental volumetric values, cortical thickness, gray matter volumes and percentage ratios of the cerebellar lobules of individuals with LMB due to trauma and in healthy individuals with bilateral sight as the control group were calculated at the volBrain CERES 1.0 website ( https://volbrain.upv.es/ ) by using brain 3D fast spoiled gradient recall acquisition in steady-state (3D T1 FSPGR) MRI sequence images in our prospective study. RESULTS: We studied 11 subjects with LMB (8 males/3 females) and 11 healthy control subjects (8 males/3 females). The mean age was 41.45 ± 14.15 and 40 ± 11.11 years, respectively (p > 0.05). The mean duration of the LMB status was 20.8 ± 11.2 years. Cerebellar lobule crus II volume and cerebellar lobule VIIB/VIIIA volume/percentage were higher in the LMB group, and mean cerebellar cortical thickness, cerebellar lobule VI-cerebellar lobule crus I-II cortical thickness, and cerebellar lobule VI gray matter volume values were lower in the LMB group (p < 0.05). CONCLUSION: In this study, cerebellar lobule VIIB/VIIIA volume/total percent ratio, cerebellar cortical thickness and cerebellar gray matter volume in the LMB group were found to be different from the control group. To our knowledge, this is the first study to report cerebellar anatomical changes in patients with LMB.

An Evaluation Using Colored Doppler Ultrasonography of Central Retinal Artery Hemodynamics in the Healthy Eye in Individuals With Late Monocular Blindness.

Structural and functional changes occur in the brain after vision losses. The purpose of the present study was to investigate central retinal artery (CRA) hemodynamics in the healthy eye of individuals developing late monocular blindness (LMB) using colored Doppler ultrasonography.The CRAs of 13 healthy eyes of 13 patients with LMB and of 13 healthy individuals as a control group were evaluated in this prospective study. Peak systolic velocity, end-diastolic velocity, mean flow velocity, systolic/diastolic velocity ratio, and resistivity and pulsatility index (RI, PI) values in the CRAs were determined using colored Doppler ultrasonography in both groups.The mean age of all the individuals examined was 39.3 ± 12.3 years, and loss of vision in the LMB patients had been present for a mean 22 ± 13.2 years. The PSH, DHS, and mean flow velocity values in the LMB group were 13.3 ± 2.5 cm/s, 3.1 ± 0.8 cm/s, and 6.5 ± 1.6 cm/s, respectively, significantly lower than in the control group at 18.6 ± 5 cm/s, 5.5 ± 2.8 cm/s, and 10 ± 3.2 cm/s (P < 0.05). The PI, RI, and systolic/diastolic velocity ratio values differences in the both group were not statistically significant (P > 0.05).In conclusion, the absence of a significant difference in RI and PI values between the 2 groups revealed that vascular resistance did not develop in the CRA hemodynamics of healthy eyes of individuals with LMB, although the low velocity values showed an increase in CRA width.

The Relationship between Ureteral Obstruction Time and Secondary Signs in Computed Tomography due to Ureteral Stone Obstruction.

OBJECTIVE: To investigate the relationship between numerical values obtained using computed tomography (CT) in stone-related urinary obstruction and the duration of obstruction. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Urology, Alanya Alaaddin Keykubat University, Turkey, from January 2018 to September 2019. METHODOLOGY: Eighty-three patients were investigated. Commencement of obstruction was defined as time of onset of pain. Cases with less than seven days elapsed between onset of obstruction; and CT were classified as acute obstruction; and those with durations of seven days or more as chronic obstruction. Bilateral renal parenchymal and renal fatty tissue densities were measured in three planes. RESULTS: Acute obstruction was present in 53 patients and chronic obstruction in 30. Median renal parenchymal densities in the obstructive and non-obstructive kidneys were 33 and 37 Hounsfield unit (HU), respectively; and median perirenal densities were 99 and 108 HU, the differences being statistically significant (p <0.05). Median perirenal density were 96 HU in acute obstruction and 104.5 HU in chronic obstruction and the difference was statistically significant (p <0.05). No statistically significant difference was determined between renal parenchymal density in acute and chronic obstruction (p >0.05). CONCLUSIONS: A low perirenal density on CT indicated prolonged duration of urinary obstruction.  Key Words: Computed tomography, Hounsfield unit, Kidney stone, Ureter, Ureteral stone.

Evaluation of the Mastoid Emissary Canals with Computerized Tomography in Patients with Chronic Otitis Media.

Background The mastoid emissary veins (MEVs) pass through the mastoid emissary canal-mastoid foramen (MEC-MF) in the mastoid region of the skull. MEVs can give rise to complications during surgical procedures. The purpose of our study was to investigate the morphological and morphometric characteristics of MECs of patients with clinical chronic otitis media (COM) using high-resolution computed tomography (HRCT). Methods Patients diagnosed with COM and undergoing temporal HRCT were identified by retrospectively scanning our hospital's automation system. Patients undergoing temporal HRCT for reasons other than COM, infection or tinnitus were identified for the control group by scanning the PACS archive. Sixty-two mastoid regions were examined in 38 unilateral and 12 bilateral COM patients, and 100 mastoid regions in the 50 patients in the control group. The presence of an accessory MEC-MF and MEC-MF diameters was evaluated in both groups. Results Main MEC diameters on the side of the ear with COM were 1.6 mm, and total accessory and main MEC diameters were 1.8 mm, both values being significantly higher than in the control group. Presence of accessory MEC on the side of the ear with COM was determined at 61.8%, significantly higher than in the control group. Conclusion Preoperative awareness of cranial venous drainage abnormalities is important to reduce surgical complications. Our study shows that MECs may be wider in diameter in patients with COM. MECs in COM patients must be identified before surgery to the mastoid region.

A patient with conventional and follicular variant papillary thyroid microcarcinoma and Eagle's syndrome, Langlais type III, with hyoid bone variation.

AIM: Presenting an extraordinary case of Eagle's syndrome (ES) with the classical and follicular variant of papillary thyroid microcarcinoma (PTmC) and an uncommon stylohyoid ligament calsification, aside from O'Carroll's System. CASE REPORT: A 52-year-old Turkish man with an histopathology of the follicular variant of PTmC (FVPTmC) of his right lobe and conventional PTmC of his left lobe of the thyroid with an adjuvant 100 mCi radioactive iodine (RAI) ablation was admitted. On the routine follow-up of the present case, a lineer structure at the 3rd compartment of neck in his ultrasonography, a styloid ligament calsification in his noncontrast computed tomography (CT), and a left styloid process of the temporal bone of 29 mm in size in his three-dimensional (3D) CT scanning had been revealed. Conclusively, an ES, Langlais Type III with The Calcification Pattern IV, was recognized. DISCUSSION: A noninvasive peroral medical management was administered as a first-line treatment for the neuropathic sequelae of ES and it has provided relief of signs and symptoms without any recurrence to date, for three years and three months. CONCLUSION: To our knowledge, it is an highly extreme and first case of ES in the English literature, recognized in the course of his programmed follow-up of his conventional PTmC and FVPTmC, simultaneously possessing an exceptional stylohyoid ligament calsification, apart from O'Carroll's System, even with an anatomic variation of the hyoid bone. KEY WORDS: Eagle's Syndrome Follicular variant of papillary thyroid microcarcinoma, Hyoid bone variation, Langlais classification, O'Carroll's System, Radioactive iodine, Papillary thyroid microcarcinoma.

Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography.

OBJECTIVE: Medications are generally administered by either the enteric or parenteral route. With parenteral administration, intramuscular (IM) is the preferred approach because it increases the bioavailability of the drug, acts more quickly than the enteric route. The aim of this study was to determine the rate of true dorsogluteal intramuscular drug injection and to determine the causes for application failures in practice by ultrasonography (US). METHODS: The study was conducted from May 1 to May 30, 2017 in Giresun University Education and Research Hospital, Giresun, Turkey. We examined 60 patients who were administered dorsogluteal IM injection with a 38.1mm length needle. After the injection, localization of medications (whether intramuscular or subcutaneous adipose tissue [SAT]) was evaluated by Ultrasound. RESULTS: Female/male ratio of the patients was 27/33, with a mean age of 39.78±2.16 years. Obese/normal weight ratio was 20/40. The mean dorsogluteal area SAT thickness of obese and normal weight patients were 32.34±2.17 mm and 20.85±1.20 mm, respectively. In 23 of the patients, IM injected drug was observed in the SAT, while it was observed in the IM area in 37 patients. Medication was observed in IM area in 37 of 50 patients who dorsogluteal region SAT thickness was appropriate (SAT thickness lower than 33.1mm) for IM injection while it was seen in SAT area in 13 patients. CONCLUSIONS: SAT thickness values are important if IM drug injection is to be administered correctly. Unsuccessful IM injections may be seen even in patients with appropriate SAT thicknesses.

Retroperitoneal Teratoma with Secondary Infection.

Teratomas are germ cell tumors arising from the embryonic germ layers. Since they originate from the germ cells, they can be found in the gonadal, sacrococcygeal, mediastinal, intracranial, retroperitoneal, and cervical regions. In this case report, a 4-year boy, brought to the hospital due to abdominal pain and fever, was diagnosed as a large and infected peritoneal teratoma by contrast-enhanced abdominal computed tomography (CT) along with abdominal CT and operative findings.

Giant colonic lipoma causing intussusception: CT scan and clinical findings.

Colonic lipomas are uncommon and usually asymptomatic tumors. A 30-year-old woman with abdominal pain lasting 10 days was admitted to the surgical clinic. Her physical examination revealed sensitivity on the right upper quadrant and her bowel sounds were normal. A lesion and invagination findings in the colon were found in the ultrasound examination and CT was performed. CT scan revealed a lipoma and invagination in the colon and the patient has undergone surgery. Pathological diagnosis of the lesion was reported as submucosallipoma. In this case report, we present clinical and radiological findings of a submucosal colonic lipoma causing intussusception.

Correlation of Clinical Findings With Computed Tomography in Orbital Traumas.

BACKGROUND: Although the eye is a well-protected organ, it is frequently affected by trauma. The timely detection of ocular injuries is extremely important. In this study, the authors evaluated the consistency between findings in computed tomography (CT) examination for orbital fractures and globe integrity and clinical findings in patients presenting to the emergency department due to orbital trauma. METHODS: The authors retrospectively reviewed the files of patients presenting with orbital trauma between January 2015 and January 2018 from emergency department records. Ophthalmology consultation and follow-up notes, radiology reports, and the emergency physician's notes were reviewed. RESULTS: During the study period, 286 patients presented to the emergency department with orbital trauma. A total of 119 eyes of 83 patients who underwent orbital CT were included in the study. Orbital bone fracture was detected in 54.6% (n = 65) of the eyes. Of these, 73.8% (n = 48) involved multiple fractures. Among all eyes, the distribution of fractures in the orbital walls was lateral wall in 41.2% (n = 49), floor in 32.8% (n = 39), medial wall in 31.1% (n = 37), and roof in 10.9% (n = 13). Multiple wall fractures were detected in 36.9% (n = 44) of the eyes. At least 1 clinical finding such as diplopia, laceration, abnormal pupillary response, hypoesthesia, and exophthalmos was observed in 47.1% (n = 56) of the eyes. This rate was 56.8% among eyes with orbital fractures and 35.2% in those without fracture. There was a statistically significant relationship between floor fractures and diplopia (P = 0.002). No significant correlations were found between the other radiological and clinical findings. CONCLUSION: Our study revealed a relationship between the presence of orbital fracture and eye damage. In particular, the authors found that the frequency of diplopia was significantly higher in eyes with maxillary bone fracture in the orbital floor. However, orbital CT findings other than bone fracture were not consistent with clinical findings.

Bilateral Post-Traumatic Facial Paralysis That Contains Longitudinal and Transverse Temporal Fracture.

Acute bilateral post-traumatic facial paralysis is rare in the literature. Post-traumatic facial paralysis is frequently accompanied transverse fractures of temporal more. The incidence of acute bilateral post-traumatic facial paralysis has been reported as 1 to 5 per million in the literature. Trauma and concurrent facial paralysis are usually in the same subsite (right temporal bone fracture and right facial paralysis). There is one pathophysiological pattern for a single temporal bone fracture in a subsite. The authors present a bilateral isolated different pathophysiological pattern sudden onset facial paralysis in a patient herein.

The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding.

OBJECTIVE: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. MATERIAL AND METHODS: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. RESULTS: The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). CONCLUSIONS: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

Evaluation of the optic nerve and scleral-choroidal-retinal layer with ultrasound elastography in glaucoma and physiological optic nerve head cupping.

AIM: To evaluate the strain ratio of the optic nerve and retina-choroid-sclera (RCS) layers in individuals with physiological optic disc cupping (PC) and glaucoma patients using strain elastography. MATERIAL AND METHODS: We evaluated 56 eyes of 56 subjects (20 eyes with glaucoma, 19 eyes with PC, and 17 normal eyes). The strain ratio of orbital fat to optic nerve (SROFON) was calculated as the ratio of the optic nerve to intraconal fat tissue and the strain ratio of orbital fat to retina-choroid-sclera (SROFRCS) was calculated as the ratio of RCS layers to intraconal fat tissue. RESULTS: SROFON was 0.92 in the control group, 1.07 in the PC group and 1.6 in the glaucoma group and a statistically significant difference was present between the three groups (p<0.05). SROFRCS had no statistically significant difference between the three groups. CONCLUSIONS:  SROFON values could contribute to the differentiation of the patients with glaucoma and PC.

Spontaneous rupture of multifocal hepatocellular carcinoma: case report.

Hemoperitoneum due to nontraumatic liver rupture is rare. The most common cause of nontraumatic rupture of the liver is hepatocellular carcinoma (HCC). The other causes of nontraumatic liver ruptures are peliosis hepatis, polyarteritis nodosa, systemic lupus erythematosus, preeclampsia, metastatic carcinoma, and other primary liver tumors. In this report, we present the computed tomography findings of spontaneous liver rupture in a 52-year-old male patient due to multifocal HCC, with the diagnosis proven by surgical specimen.