Effects of balneological outpatient treatment on clinical parameters and serum cytokine levels in patients with chronic low back pain: a single-blind randomized controlled trial.

This study aimed to investigate the effects of balneological outpatient treatment (hydrotherapy and peloidotherapy) on clinical status and serum cytokine levels in patients with chronic low back pain (CLBP). Seventy-four patients with CLBP who accepted to participate to the study were randomly divided into two groups. The study group was given ten sessions (in 2 weeks) of hydrotherapy, peloidotherapy, and home exercise, while the control group was given only home exercise. All patients were assessed before and at the end of therapy, at the 1st and 3rd months. The primary outcomes were pain intensity on the visual analog scale (VAS) (VAS-pain, VAS-rest, VAS-exercise) and Oswestry Disability Index (ODI). The secondary outcome measures included patient's and physician's global assessment (VAS-PGA), (VAS-DGA), finger-to-floor distance (FFD), modified Schober test, Short Form-36 (SF-36), and the use of analgesic drug. Venous blood samples were drawn from all patients before/1st day and after therapy/12th day to measure serum interleukin (IL)-6 and IL-10 levels. Significant improvement was observed in the study group in VAS-pain, VAS-rest, VAS-exercise, VAS-PGA, VAS-DGA, ODI, and SF-36 parameters after treatment and improvement maintained for 3 months. In the control group, significant improvement was observed in VAS-pain, VAS-exercise, VAS-PGA, VAS-DGA, and ODI scores on the 12th day and continued for 3 months. Decrease in pain, pain during rest and exercise, modified Schober test, VAS-PGA, VAS-DGA, ODI scores, and the increase in SF-36 pain and general health scores showed superiority in favor of the study group in all evaluations. There was a significant increase in IL-10 values from baseline at the end of treatment in the study group. The use of non-steroidal anti-inflammatory drug (NSAID) was significantly lower in the study group compared with the use of NSAID in the control group in the 3rd month. Balneological outpatient treatment improved clinical status in CLBP patients. Although no significant correlation was clearly determined between IL-10 levels and pain score, this effect might be related to the observed increase in the anti-inflammatory cytokine IL-10 levels that was observed only in the study group.

Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate.

INTRODUCTION: Accurate localisation of the abnormal hyperfunctioning gland with preoperative imaging has a critical role in parathyroid surgery to obtain a successful outcome. This study aimed to evaluate the diagnostic performance of second-line imaging and their contribution to the treatment success in primary hyperparathyroidism when the first-line methods were negative or discordant. METHODS: Among the patients who underwent parathyroidectomy due to primary hyperparathyroidism, 33 who underwent four-dimensional computed tomography and/or four-dimensional magnetic resonance imaging because of negative or discordant first-line imaging results were included. Persistent and recurrent cases were excluded. RESULTS: The majority of the patients were female (84.8%) and the mean age was 59.2 years. Seventeen patients had four-dimensional computed tomography and 25 had four-dimensional magnetic resonance imaging, respectively. Four-dimensional computed tomography and four-dimensional magnetic resonance imaging localised the culprit gland successfully in 52.9% and 84%, respectively. Twenty-five patients in whom single adenoma was detected underwent focused parathyroidectomy. The culprit gland was solitary in 32 cases and one patient had double adenoma. Normocalcaemia was achieved in all cases. Among the 29 patients who completed their postoperative sixth month success rate was 100%. CONCLUSION: Four-dimensional magnetic resonance imaging had high accuracy with fast dynamic imaging in detecting parathyroid adenomas. When the first-line imaging methods were negative or inconclusive, four-dimensional magnetic resonance imaging should be considered primarily since it is cost effective in Turkey and emits no radiation.

Anatomic variations associated with antrochoanal polyps.

OBJECTIVE: Although more than a century has passed since antrochoanal polyps (ACPs) were first defined, etiopathogenesis still remains unclear. The aim of this study was to investigate the relationship between ACPs and sinonasal cavity variations. SUBJECTS AND METHODS: One hundred and forty-four patients with ACP on paranasal sinus computed tomography scans (ACP group) and 160 paranasal sinuses without ACP (control group) were included into the study. The study group was evaluated in respect of the presence of retention cyst in the contralateral maxillary sinus and sinus bone wall sclerosis thickening. Both groups were also compared with respect to the frequency of sinonasal anatomic variations, nasal septal deviation, variations of the uncinate process insertion, concha bullosa, paradoxical middle turbinate, and accessory maxillary sinus ostium. In the ACP group, the cases with septal deviation (SD) were also evaluated whether the deviation convexity was towards the polyp side or the opposite side. In addition, the posterior extension of ACPs were evaluated in three groups as middle meatus, nasopharynx, and oropharynx extension. RESULTS: The prevalence of retention cyst, sinus wall sclerosis thickening, SD, and accessory maxillary ostium was significantly higher in the ACP group. A negative directional correlation was determined between the SD side and ACP side. When the ACP extensions were examined, middle meatus extension was seen in 32.6%, nasopharynx in 56.3%, and oropharynx in 11.1%. CONCLUSION: Accessory ostium may be an accelerating factor in the transformation of retention cyst to ACP. Furthermore, the changes in the nasal passage airflow on the opposite side suggest that SD contributes to this process.

Preventing intraperitoneal adhesions with ethyl pyruvate and hyaluronic acid/carboxymethylcellulose: a comparative study in an experimental model.

OBJECTIVE: To compare the effectiveness of ethyl pyruvate (EP) with that of hyaluronic acid+carboxymethyl cellulose (Seprafilm) for the prevention of intraperitoneal adhesions. Seprafilm has been shown to be effective in many experimental and clinical studies. STUDY DESIGN: Thirty rats were divided into three groups at random, and uterine horn abrasion was performed by laparotomy. One group received no treatment (control group), one group received a single intraperitoneal dose of EP 50mg/kg (EP group), and a 2×1-cm patch of Seprafilm was applied in the third group (Seprafilm group). All rats were killed 14 days after surgery. Macroscopic and histopathological evaluation were performed by a surgeon and a pathologist who were blinded to group allocation. Histopathologically, inflammation, fibroblastic activity, foreign body reaction, collagen proliferation, vascular proliferation, Masson-Trichrome score, matrix metalloproteinase-2 score and vascular endothelial growth factor score were studied. RESULTS: Median macroscopic intraperitoneal adhesion scores for the control, EP and Seprafilm groups were 2.8, 1.2 and 1.1, respectively. Multiple comparisons between groups showed a significant difference (p<0.05). In binary comparisons, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p<0.05). No significant difference was found between the adhesion scores for the EP group and the Seprafilm group (p>0.05). After histopathological evaluation, significant differences in all parameters were found between the groups (p<0.05). In the paired comparison, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p<0.0167), but no significant difference was found between the EP group and the Seprafilm group (p>0.0167). CONCLUSIONS: In comparison with the untreated control group, EP and Seprafilm were found to reduce the formation of intraperitoneal adhesions. No significant difference was found between EP and Seprafilm.

High risk HPV in situ hybridization, p16 INK 4A, and survivin expressions in cervical carcinomas and intraepithelial neoplasms: evaluation of prognostic factors.

BACKGROUND: Cervical carcinoma (CC) is one of the most important health problems of adult women in developing countries. CC is the second most common carcinoma of the women worldwide. Efficient screening and early therapeutic programmes are vital because of the higher burden of the disease. MATERIALS AND METHODS: The authors included a total of 53 cases in this study. Distribution of diagnoses among cases was as follows: cervical intraepithelial neoplasm (CIN) (n=44), squamous cell carcinoma (SCC) (n=7), adenocarcinoma in situ (n=1), and condyloma accuminatum (n=l). Presence, density, and nuclear identification form of human papilloma virus (HPV) DNA in relation with host cell DNA were evaluated by in situ hybridization (ISH) and p16 and survivin by immunohistochem- ical methods (IHC). RESULTS: The authors determined that the presence, density, and nuclear identification form of high risk HPV DNA had diagnostic and prognostic importance in CC and CIN (p < 0.05). p16 and survivin also had diagnostic significance. Since p16 and survivin expressions signalled progressive oncogenic events, p16 and survivin were persistent HPV markers (for p16, p < 0.001, for survivin p < 0.01). The authors determined that expressions, density, and prevalence of all three markers showed correlation with increasing CIN grade (for p 16, p < 0.001, for survivin, p < 0.01, for HPV, p = 0.002). The episomal pattern which is the independent visit of Hr HPV DNA to host cell DNA, signalled early HPV infection (p = 0.001). When it is integrated into host cell DNA, especially if HPV DNA signal intensity and prevalence increases, then this signal signifies persistent HPV infection (p = 0.001). CONCLUSION: With the aid of these findings, the authors determined that HPV is infectious in CIN I and proliferative (neoplastic) in CIN II-CIN III lesions.

Hand measurements in the follow-up of acromegaly.

Acromegaly is a chronic progressive disease that originates from the increased secretion of the insulin-like growth-hormone (IGF-1) secondary to the hypersecretion of the growth hormone (GH). The enlargement of the minor hand and foot bones represents an early finding in this disease. Kleinberg et al. used the sesamoid index (SI) values for diagnosing the disease. The present trial was designed to investigate whether there was a difference between the control patients and the treated acromegalic patients in the SI, the terminal tuft width, the joint space and the metacarpal thickness. 34 patients were diagnosed and treated for acromegaly at the Rheumatology and Endocrinology Outpatient Clinics and 26 control patients presenting to the Rheumatology Outpatient Clinic, who were not detected to have an inflammatory rheumatologic pathology were enrolled. The hand radiographs of the patients that followed up for acromegaly and the control group were retrospectively evaluated. The SI, the tuft width, the joint space and the metacarpal thickness were measured. There was a statistically significant difference in the other parameters between the acromegalic patients and the control patients except the mean metacarpal thickness.

Diagnostic value of liquid-based (Liqui-PREP) preparations and interobserver reproducibility in fine needle aspiration cytology of the nodular thyroid lesions.

The aim of this study is to define the diagnostic role of Liqui-Prep (LP) technique for the diagnosis of thyroid lesions and to assess interobserver variabilities. In all, 98 thyroid FNA (fine needle aspiration) cytology samples from 83 patients for preoperative evaluation of thyroid nodules, prepared by the LP, were examined. The LP slides were independently evaluated by three pathologists and they were classified into the five categories according to the Bethesda system. The histopathologic diagnoses were grouped as follows: benign, follicular neoplasm, and malignant. Agreements between LP and histopathologic diagnoses were investigated using kappa values. Marginal homogenity and kappa tests were used for statistical analysis for the evaluation of the agreement between the pathologists and the interobserver variability of the thyroid aspiration cytology results. The presence of nucleoli, nuclear grooving, overlapping, intranuclear inclusion, and nuclear irregularity were recorded and scored on each case based on LP slide review. Concurrences between LP and the histologic diagnoses for the three pathologists were almost perfect (k = 0.798; k = 0.826; k = 0.880). When the observers were paired there was no significant difference from the diagnostic point of view. Interobserver agreement among the three pathologists was moderate. Initially diagnostic difficulties may occur because of the inadequate experience of the pathologists concerning the evaluation of the cytologic changes associated with this new technique. Liqui-Prep technique is useful for the cytologic diagnosis of the thyroid nodules. The nuclear irregularity was the most essential feature for the differentiation of malignant lesions from follicular neoplasm by the LP method.

Effect of recirculation on organic matter removal in a hybrid constructed wetland system.

This research project aimed to determine the technologically feasible and applicable wastewater treatment systems which will be constructed to solve environmental problems caused by small communities in Turkey. Pilot-scale treatment of a small community's wastewater was performed over a period of more than 2 years in order to show applicability of these systems. The present study involves removal of organic matter and suspended solids in serially operated horizontal (HFCW) and vertical (VFCW) sub-surface flow constructed wetlands. The pilot-scale wetland was constructed downstream of anaerobic reactors at the campus of TUBITAK-MRC. Anaerobically pretreated wastewater was introduced into this hybrid two-stage sub-surface flow wetland system (TSCW). Wastewater was first introduced into the horizontal sub-surface flow system and then the vertical flow system before being discharged. Recirculation of the effluent was tested in the system. When the recirculation ratio was 100%, average removal efficiencies for TSCW were 91 +/- 4% for COD, 83 +/- 10% for BOD and 96 +/- 3% for suspended solids with average effluent concentrations of 9 +/- 5 mg/L COD, 6 +/- 3 mg/L BOD and 1 mg/L for suspended solids. Comparing non-recirculation and recirculation periods, the lowest effluent concentrations were obtained with a 100% recirculation ratio. The effluent concentrations met the Turkish regulations for discharge limits of COD, BOD and TSS in each case. The study showed that a hybrid constructed wetland system with recirculation is a very effective method of obtaining very low effluent organic matter and suspended solids concentrations downstream of anaerobic pretreatment of domestic wastewaters in small communities.

Asymmetric dimethylarginine (ADMA) levels are increased in patients with fibromyalgia: correlation with tumor necrosis factor-α (TNF-α) and 8-iso-prostaglandin F(2α) (8-iso-PGF(2α)).

OBJECTIVE: The aim of the study was to investigate serum levels of asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and plasma levels of 8-iso-prostaglandin F(2α) (8-iso-PGF(2α)) in patients with fibromyalgia. DESIGN AND METHOD: Twenty-seven patients with fibromyalgia and twenty healthy controls were enrolled in this study. ADMA, TNF-α, IL-6 and 8-iso-PGF(2α) levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of ADMA and TNF-α and plasma levels 8-iso-PGF(2α) were significantly increased in patients with fibromyalgia compared to controls. However, no significant difference was observed in IL-6 levels between the two groups. ADMA concentrations were positively correlated with TNF-α and 8-iso-PGF(2α) levels in patients with fibromyalgia. CONCLUSION: This is the first study reporting that ADMA levels are significantly elevated in patients with fibromyalgia in association with increased 8-iso-PGF(2α) and TNF-α concentrations. Thereby, ADMA could be suggested as a reliable marker of endothelial dysfunction in patients with fibromyalgia.

Bilateral partial ureteral duplication with double collecting system in horseshoe kidney.

The horseshoe kidney is the most common renal fusion anomaly. Approximately one-third is associated with other congenital anomalies. The combination of horseshoe kidney and bilateral ureteral duplication is a very rare entity. The horseshoe kidney anomaly discovered incidentally in ultrasound examination in our patient when he was being detected for urinary incontinence. Because he had dilated renal pelvis he had undergone intravenous pyelography (IVP). Bilateral double collecting system and bilateral partial hydronephrosis was detected on IVP. Magnetic resonance urography was also performed in the same patient for better delineation.

Relationship between polymorphism in the manganese superoxide dismutase gene and breast cancer.

Manganese superoxide dismutase (MnSOD) acts as an antioxidant and protects cells from the harmful effects of reactive oxygen species. We investigated the relationship between the MnSOD Ala-9Val polymorphism and breast cancer. Genotypes of 250 cases and 330 controls were determined by use of PCR-RFLP. Compared with the MnSOD Val/Val genotype, the MnSOD Val/Ala or MnSOD Ala/Ala genotype was not significantly associated with the overall risk for breast cancer. The risk increased in women with MnSOD Ala allele-containing genotypes as well as higher level of education (Ala/Ala: OR, 6.00; 95% CI, 1.02-35.33), BMI >or= 25 kg/m(2) (Val/Ala: OR, 1.74; 95% CI, 1.10-2.76), late age at first pregnancy (Val/Ala: OR, 1.52; 95% CI, 1.01-2.42), and premenopausal status (Val/Ala: OR, 1.78; 95% CI, 1.03-3.10). In conclusion, the MnSOD Ala-9Val polymorphism may contribute to an increased risk for breast cancer development, particularly in the presence of a higher level of education, high BMI, late age at first pregnancy, and premenopausal status.

The prevalence of iodine deficiency, serum thyroglobulin, anti-thyroglobulin and thyroid peroxidase antibody levels in the urban areas of Kayseri, Central Anatolia.

BACKGROUND: The prevalence of goitre and urinary iodine excretion (UIE) indicate endemic iodine deficiency (ID) in a population. Previous studies have shown that Kayseri is one of the most iodine-deficient areas in Turkey. The aim of this study was to determine the prevalence of goitre, evaluate the degree of ID, its effects on thyroid functions and volume of subjects living in wide outer skirts of the old volcano Erciyes, at 1655 m and 1350 m altitudes. METHODS: UIE was determined in 209 school-age children (SAC) aged between 10 and 14 years and in 183 adults. Thyroid volume (TV) of subjects was performed used by both palpation and ultrasonography (USG). In addition, serum free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), thyroglobulin (Tg), anti-Tg and anti thyroid peroxidase (TPO) antibody levels were measured. RESULTS: The prevalence of goitre according to palpation and USG among SAC was found as 50.7 and 58.4% respectively, as 65.0 and 57.9% among adults. Although mean UIC of whole subjects was 30+/-34 microg/l indicated moderate iodine (I) deficiency, 55.4% of the subjects' UIE was <20 microg/l. While the serum fT3, TSH, anti-TPO, Tg levels, body mass index (BMI), TV of SAC and adults (except BMI) with goitre were higher than those of without goitre, serum fT4 and UIE were lower than those of without goitre. CONCLUSIONS: The population living in two areas was exposed to consequences of severe and moderate ID and also endemic goitre due to geographical characteristics of the area. A plan of action including sufficient I intake of people should be planned and be implemented effectively.

Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe.

BACKGROUND: Minimally invasive parathyroidectomy (MIP) is widely used worldwide for the treatment of primary hyperparathyroidism (pHPT). It is usually combined with a perioperative adjunct for high success rate. AIM: To demonstrate that MIP can be successfully performed in a selected group of patients with presumabally solitary adenoma as the cause of pHPT without using any perioperative adjuncts. SETTINGS AND DESIGN: A prospective data analysis of two surgeons' series from a teaching hospital in Turkey. MATERIALS AND METHODS: Of the 47 patients referred with a diagnosis of pHPT during January 2004-May 2008, 30(63%) patients with sporadic pHPT with presumed solitary adenoma were included for analysis. These patients underwent MIP via focused lateral (n=24) or anterior (n=6) approach. Preoperative localization was done using 99 mTc-labelled sestamibi scan and ultrasonography. Only patients with concordant tests for single adenoma were selected for MIP. Serum parathyroid hormone and calcium levels were measured postoperatively and at follow-up visits. STATISTICAL ANALYSIS: Parametric data presented were analyzed with Excel XP (Microsoft, Redmond, WA, USA). RESULTS: Barring one patient, all other patients were initially biochemically cured by MIP. One patient remained hypercalcemic, who was found to have a second adenoma at the second operation. During a mean follow-up of 16 (3-55) months, all patients were normocalcemic with a mean serum calcium level of 9.4 (8.9-10.2) mg/dl. Parathormone levels were persistantly elevated only in one patient (3.4%). No postoperative permanent complication was encountered. CONCLUSION: The results of MIP achieved in high-volume endocrine surgery centers can be replicated in low-volume center without any intraoperative adjuncts, in patients with overt clinical pHPT and concordant results of sestamibi and ultrasound.

The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine-needle aspiration cytology of liver masses.

OBJECTIVE: The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on-site cytopathological evaluation improves the diagnostic yield of liver fine-needle aspiration cytology (FNAC). METHODS: Ultrasound-guided FNABs were performed on 323 consecutive cases with liver masses between December 2002 and December 2004. Histologically and/or clinically correlated 167 cases were included in the study. Preliminary FNAB results, results of CS, CB, and combined use of CS and CB were compared regarding diagnostic sensitivity, specificity, and accuracy for the diagnosis of malignancy. Subtyping accuracies of different methods were also compared. RESULTS: The sensitivity of on-site cytopathological examination and CS were both 92.8%. The sensitivity of CS + CB was slightly better than that of CB (93.5% versus 84.8%). Specificity of all procedures was achieved 100%. Diagnostic accuracy of on-site cytopathological evaluation, CS, CB, and CS + CB were 93.9%, 93.9%, 87.2%, and 94.5%, respectively. A specific subtype diagnosis of malignant tumours could be rendered accurately on the basis of preliminary diagnosis in 71%, CS in 75.4%, CB in 78.3% and combined approach in 92% of cases. In terms of typing accuracy, 87.5% of HCCs, 93.2% of adenocarcinomas, 92.3% of neuroendocrine carcinomas, 100% of lymphomas and 100% of other malignant tumours were correctly subclassified in the final cytopathological diagnosis. The agreement between preliminary diagnosis and final cytopathological diagnosis was 77.2%. CONCLUSION: With use of on-site cytopathological evaluation and combined use of CS and CB, the diagnostic accuracy of liver tumours approaches 100% and also significantly improve diagnostic and subtyping accuracy of liver malignancies.

Tongue abscesses: MR imaging findings.

BACKGROUND AND PURPOSE: A lingual abscess is difficult to diagnose in the absence of physical signs. MR imaging may provide an excellent and invaluable adjunct to clinical examination, but the literature is incomplete in defining the various MR imaging findings of abscess. The objective of this study was to determine the MR imaging features of tongue abscesses. METHODS: Seven surgically proved tongue abscesses were evaluated with MR imaging. Four patients underwent MR imaging because of suspected tumor, and 3 patients, to show the extent and precise anatomic location of the lesion. Lesions were assessed with regard to the location, size, signal-intensity characteristics, and pattern of contrast enhancement. RESULTS: Five lesions were located in the anterior tongue and 2, in the posterior tongue. The central parts of 4 anterior tongue abscesses were hypointense, surrounded by a hyperintense wall on T1-weighted precontrast images. On postcontrast images, marked wall enhancement was detected. On T2-weighted images, a markedly hyperintense central part surrounded by a hypointense rim was seen. In 2 of these patients, there was a hypointense halo surrounding the wall (target sign). In 3 patients, a perilesional hyperintense area that enhanced diffusely after contrast administration was detected on T2-weighted images. The smallest lesion located in the anterior tongue was hypointense on T1-weighted images and enhanced diffusely on postcontrast images. On T2-weighted images, a markedly hyperintense central part surrounded by a mildly hyperintense peripheral part was depicted. Posterior tongue lesions appeared as polypoid ill-defined masses and were hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images. On postcontrast images, the lesion in 1 patient showed diffuse and heterogeneous contrast enhancement, whereas the lesion in another patient enhanced peripherally. The lesions were totally excised in 4 patients and drained with surgical incisions in 3 patients. No recurrence was detected on follow-up. CONCLUSION: An abscess typically presents as a cystic lesion surrounded by an enhancing capsule formation, but lesions may also present as solid masses that enhance diffusely or peripherally.

Seizure development after stroke.

Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.

Ultrasound guidance in intracranial tumor resection: correlation with postoperative magnetic resonance findings.

PURPOSE: To determine the inter-method agreement between intraoperative ultrasonography and postoperative contrast-enhanced magnetic resonance imaging (MRI) in detecting tumor residue. MATERIAL AND METHODS: After resection was completed, the cavity borders of 32 tumors were examined with a 7 MHz intraoperative probe. Any echogenic region >5 mm in thickness extending from the surgical cavity into the brain substance was taken as the sonographic criterion for residual tumor. A continuous echogenic rim< 5 mm was considered normal. Results were correlated with gadolinium-enhanced MRI obtained within 48 h after surgery. RESULTS: The kappa value for inter-method agreement was 0.72. There were four cases in whom MRI showed residue despite a negative sonography: extensive edema or Surgicel along the cavity borders (three cases with glioblastoma multiforme) and the cystic component in the vicinity of cerebrospinal fluid (a case with pituitary macroadenoma) may be the reason for the residue going undetected. In a case with glioblastoma multiforme, residual enhancement was < 5 mm in thickness. CONCLUSION: Intraoperative ultrasound is an effective tool for maximizing the extent of intracranial tumor resection. Surgical use has to be minimized if intraoperative ultrasound is to be used as an adjunct to surgery. Tumors with preoperatively detected cystic components in the proximity of CSF-containing spaces have to be carefully evaluated with intraoperative ultrasound if residual cystic components are to be detected. A low-thickness echogenic rim should not be considered a reliable sign of the absence of residue.

Doppler ultrasound assessment and serum cancer antigen 125 in the diagnosis of ovarian tumors.

OBJECTIVE: To differentiate benign from malignant ovarian tumors based on sonographic detection of a solid component. METHOD: Sixty-three women with ovarian masses were evaluated preoperatively by gray scale and power/color Doppler ultrasonographic examination, with specific predefined criteria for the solid component. Sensitivity, specificity, and positive and negative predictive values were calculated and assessed against the histopathologic outcome. The contribution of cancer antigen (CA) 125 levels to the diagnostic accuracy was also assessed. RESULT: Sensitivity, specificity, and positive and negative predictive values were 100%, 95.2%, 91.3% and 100%, respectively, with two false-positive results. Had an elevated CA 125 level (>35 U/mL) been included in the malignancy criteria, the false-positive results would have been eliminated, giving an accuracy of 100%. CONCLUSION: Sonographic evaluation with predefined specific criteria for the detection of a solid tumor component is an accurate method of preoperative discrimination between benign and malignant ovarian tumors. A serum CA 125 assay may assist in eliminating false-positive results.

Diffusion-weighted and conventional MR imaging in neurotrichinosis.

Central nervous system involvement in trichinosis is not rare. Brain lesions in trichinosis have been defined on computed tomography and magnetic resonance imaging (MRI) as multifocal small lesions located in the cerebral cortex and white matter. We present a case of trichinosis with multifocal lesions of the brain detected by MRI and diffusion weighted MRI. Evolutions of these lesions from acute through chronic stages on follow up studies are also presented. This is the first report describing sequential MRI findings and diffusion weighted imaging appearance of brain lesions in trichinosis. Sequential evaluation of conventional and diffusion MR data allowed us to conclude that multifocal lesions in the brain were related to multiple infarctions rather than true inflammatory infiltration of the brain parenchyma.