Evaluation of Femoral Head Avascular Necrosis With Virtual Noncalcium Dual-Energy Computed Tomography.

OBJECTIVE: Our aim was to investigate the effectiveness of the dual-energy computed tomography (DECT) virtual noncalcium (VNCa) technique in avascular necrosis (AVN) for detecting bone marrow edema (BME) and staging. METHODS: This prospective study included adult patients diagnosed with unilateral or bilateral femoral head AVN between January 2023 and December 2023, who had magnetic resonance imaging (MRI) and DECT. Two participants were excluded from the study due to undergoing surgical procedures during the period between the scans. Two reviewers, blinded to MRI images and clinical data, visually examined color-coded VNCa pictures to assess BME using a binary classification (0 = normal bone marrow, 1 = BME). Same 2 reviewers also used color-coded and nonmapped images to stage AVN in accordance to the "Association for Research on Osseous Circulation" (ARCO) staging system. Interobserver agreements for the visual evaluation and staging were calculated with κ coefficient. Following a visual assessment of BME and the staging of AVN, same 2 reviewers conducted CT density measurements on regions of BME regions utilizing DECT noncalcium images. An independent third investigator (reference standard) utilized MRI, x-ray, and clinical data to confirm the definitive diagnosis and staging of AVN. A P value less than 0.05 was considered statistically significant. RESULTS: Fifty patients (28 men, 22 women, mean age: 44.2 ± 13.1 years, range: 25-75 years) were included in the final analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the VNCa technique in detecting BME were 96.0%, 94.4%, 97.9%, 89.4%, and 95.6%, respectively, for reviewer 1; and 96.0%, 88.9%, 96.0%, 88.9%, and 94.1%, respectively, for reviewer 2. Interobserver agreement was almost perfect ( κ = 0.84). Both reviewer 1 and reviewer 2 accurately classified 92.7% of the AVNs. The density measurements showed a statistically significant difference ( P = 0.001) between the edema regions and the normal marrow regions. No statistically significant difference was observed in the density measurements of edema regions at different stages ( P = 0.13). CONCLUSIONS: DECT VNCa technique exhibits excellent performance in detecting BME in hip AVN cases, as well as accurately determining the stage of AVN.

Interaction of talus and calcaneus morphometric values and estimation of carcass weight in cattle.

In this study, the calcaneus and talus bones of 20 male and female adult Simmental and Angus cattle were used. The age and sex of these animals were recorded before slaughter, and carcass weights were taken after slaughter. Calcaneus and talus morphometric measurements were used to obtain multipliers that allow the estimation of the carcass weight. These multipliers were found to be mean values of 3.346 and 4.642, respectively. Thus, multipliers were obtained that can be used in the evaluation of chronological differences in archaeological cattle size and consequently carcass weight. LSM (Least Square Means) analysis of calcaneus and talus GL values revealed the effect of sex but not of breed. Proportional factors were obtained for calcaneus and talus pairings and associated bone size (GL) estimates.

Complementary comments on diagnosis, severity and prognosis prediction of acute pancreatitis.

The radiological differential diagnosis of acute pancreatitis includes diffuse pancreatic lymphoma, diffuse autoimmune pancreatitis and groove located mass lesions that may mimic groove pancreatitis. Dual energy computed tomography and diffusion weighted magnetic resonance imaging are useful in the early diagnosis of acute pancreatitis, and dual energy computed tomography is also useful in severity assessment and prognosis prediction. Walled off necrosis is an important complication in terms of prognosis, and it is important to know its radiological findings and distinguish it from pseudocyst.

Evaluation of Periorbital Edema and Ecchymosis After Osteotomy in Septorhinoplasty Cases by Measuring Bone Density and Thickness.

PURPOSE: Periorbital edema and ecchymosis that may occur after surgery in septorhinoplasty patients who have undergone lateral osteotomy are common morbidities and are seen as the main limiting factors for the recovery process of the patients. There are many different studies in the literature about the causes of periorbital edema and ecchymosis. In this study, the authors aimed to investigate the possible relationships between the bone density and bone thickness measured in the frontal process of the maxillary bone, and postoperative periorbital edema and ecchymosis, which are suitable for the osteotomy lines that they will detect in computerized tomography. METHODS: Between January 1, 2019 and November 11, 2020, 59 patients whose nasal pathologies were determined by paranasal sinus computed tomography examination due to nasal deformity and nasal deformity and who underwent septorhinoplasty operation were included in this study. Bone density and thickness measurements were performed on the frontal process of the maxillary bone in accordance with the lateral osteotomy lines on the lateral nasal wall in each patient, right and left side. According to the bone density values measured at the point determined on the lateral osteotomy line, 2 groups were formed as "very dense" and "less dense." According to the bone thickness values of the patients, 2 groups were determined as "thick" and "thin." Thus, the authors investigated the relationship between periorbital edema and ecchymosis on the postoperative first, third, and seventh days obtained from the examination files of the patients. FINDINGS: When bone density subgroups are examined, it has been shown that the degree of periorbital edema of the patients in the "very dense" and "less dense" group categories decreased from the first day to the seventh postoperative day. The degrees of periorbital edema on the third postoperative day were statistically higher in the "less dense" group than in the "very dense" group. In the authors' study, no correlation was found between the degrees of postoperative periorbital edema and ecchymosis and bone density subgroups on other days. While an increase was observed in the periorbital ecchymosis grades of the patients in the "less dense" subgroup category from the first day to the third postoperative day, the periorbital ecchymosis grades of the patients in the "very dense" subgroup category decreased from the first day to the third day. In both subgroups, the lowest periorbital ecchymosis levels were observed on the postoperative seventh day.When bone thickness subgroups are examined, it has been shown that the degree of periorbital edema of the patients in the "thick" and "thin" group categories decreases from the first day to the seventh day postoperatively. When the bone thickness subgroups were examined, the periorbital ecchymosis degrees of the patients in the "thick" and "thin" group categories increased on the third postoperative day, while it reached the lowest level on the postoperative seventh day. There was no significant difference between the first, third, and seventh-day periorbital edema and ecchymosis conditions in the "thick" and "thin" groups. CONCLUSION: The authors observed that periorbital edema and ecchymosis that may occur after septorhinoplasty can be affected by the variable features of the lateral nasal wall bone structure. The authors conclude that the changes in the healing process can be affected by different bone density values in particular.

Determination of Multimycotoxin in Cereal-Based Products Sold in Open-Air Markets.

In this study, a total of 140 cereal-based foods sold in temporary open-air markets were analyzed by LC-MS/MS for aflatoxin B1, B2, G1, G2, ochratoxin (OTA), zearalenone (ZEN), deoxynivalenol (DON), fumonisin B1, fumonisin B2, citrinin (CIT), HT-2, and T-2 toxins. Breakfast cereals (n:27), cornmeal (n:41), extruded maize (n:32), and oatmeal (n:40) purchased from these alternative shopping areas created to meet the food needs of low-income people in the suburbs formed the sample set of the study. These foods, which are sold in areas that are out of legal control and greatly affected by external environmental conditions, are more open to health risks. Mycotoxins, chemicals of a biological origin, are some of the most important of these risks. In terms of public health, it is important to investigate the presence of mycotoxins in foods, which can cause acute and chronic diseases such as immunosuppression, genotoxic, estrogenic, teratogenic effect, cancer, and liver and kidney dysfunctions. Grain-based foods are often contaminated with a large number of mycotoxins, but legal regulations have not been prepared that consider the health risks associated with the co-existence of mycotoxins. Many of the studies have focused on the presence of a single mycotoxin and the risks it poses. As a result, aflatoxin B1 levels in 28.57% of the samples and total aflatoxin (B1 + B2 + G1 + G2) levels in 26.43% of the samples were determined to exceed the limits defined in the "Turkish Food Codex Contaminants Regulation". Citrinin could not be detected in any of the samples. The rate of mycotoxin occurrences above the limit of detection (LOD) in grain-based food samples ranged from 22.86% to 99.29%. Total aflatoxin (TAF) + Total Fumonisin (FUM) were found in 83.57% of the samples; TAF + FUM + OTA in 82.14%; TAF + FUM + OTA + T-2 in 44.29%; TAF + FUM + OTA + DON + HT-2, TAF + FUM + OTA + DON + T-2, and TAF + FUM + OTA + DON + ZEN in 22.86% of the samples.

Neglected areas on thorax computed tomography evaluation in patients with chronic obstructive pulmonary disease: Paravertebral muscles and para-aortic adipose tissue.

INTRODUCTION: This study, investigated the para-aortic adipose tissue cross-sectional area, a novel predictor of cardiovascular diseases and degenerative changes in the paravertebral muscles, in patients with chronic obstructive pulmonary disease (COPD). METHOD: One hundred cases diagnosed as COPD and 50 healthy individuals with similar demographic characteristics were evaluated. Para-aortic adipose tissue cross-sectional area (mm2 ), subcutaneous adipose tissue thickness (mm), paravertebral muscle area (mm2 ) and fat deposition in muscle tissue were assessed radiologically. RESULTS: Paravertebral muscle mass was lower in the patient group compared to the healthy individuals (471.41 ± 157.71 mm2 and 561.58 + 151.03 mm2 , respectively; P = 0.001). Paravertebral muscle attenuation values were also lower in the patient group, and the grade of deposition increased (P = 0.012 and P = 0.045, respectively). Although subcutaneous adipose tissue thicknesses were similar in the patient and control groups, para-aortic adipose tissue cross-sectional area was higher in the patients with COPD than in the control group (439.34 ± 267.17 mm2 and 333.82 ± 165.23 mm2 , respectively, P = 0.012). The correlation between subcutaneous adipose tissue and para-aortic adipose tissue observed in the healthy group was not present in the subjects with COPD. CONCLUSION: Chronic obstructive pulmonary disease causes morphological changes in paravertebral muscles and para-aortic adipose tissue. Degenerative changes in the paravertebral muscles occur secondary to systemic inflammation, comorbidity and drugs used in COPD. Factors such as insulin resistance and steroid use result in an increase in para-aortic adipose tissue mass.

Malignant fibrous histiocytoma in a patient presenting with urinary system symptoms

Summary Malignant fibrous histiocytoma is a rare tumor. It is most commonly seen in individuals between the fifth and seventh decades of life, in extremities, and less frequently in the retroperitoneum. Although its etiology is not clearly known, radiotherapy, chemical agents, previous history of surgery, trauma and fracture, and Hodgkin lymphoma have been blamed. Leiomyosarcoma, liposarcoma and rhabdomyosarcoma should be taken into account in differential diagnosis. It is seen on computed tomography as a mass lesion with irregular borders and density similar to that of the surrounding muscle tissue. Necrotic and hemorrhagic components in the mass are characterized as heterogeneous low density areas. Fluid-fluid levels can be detected by computed tomography and magnetic resonance imaging.

Amyand's hernia detected incidentally in two patients.

The appendix is rarely present inside the inguinal hernia sac. The risk of appendicitis increases in these patients since the blood supply to the appendix can be impaired. The condition is frequently asymptomatic, and even if symptomatic it gives rise to non-specific symptoms. There is no specific laboratory finding. Diagnosis is frequently made with radiological imaging. We report two cases diagnosed as Amyand's hernia with CT.

Prevalence of Staphylococcal Enterotoxins in Ready-to-Eat Foods Sold in Istanbul.

The aim of this study was to investigate the prevalence of staphylococcal enterotoxins (SEs) in ready-to-eat (RTE) foods sold in Istanbul, Turkey. A total of 5,241 samples were randomly collected from various caterers, hotels, and restaurants from 2014 to 2016. The samples were classified into four groups: (i) various cooked RTE meat and vegetable meals, (ii) various RTE salads, charcuterie, and cold appetizers, (iii) various cooked RTE bakery products (pasta, pastries, pizza, pita, ravioli, etc.), and (iv) any cooked RTE sweets and desserts (pudding, custard, cream, ashura, etc.). The samples were examined for the presence of SEs by 3M Tecra Staph Enterotoxin Visual Immunoassay method, which is a manual enzyme-linked immunosorbent assay method. Among all samples, only 1 (0.019%) RTE meal (vegetable meal with meat) was found to be contaminated with SEs, a good result in terms of staphylococcal food poisoning risk and public health.

Retroperitoneal haemangiopericytoma.

A 55-year-old woman, diagnosed with a renal mass by abdominal ultrasonography (USG) in an external medical centre, presented to our hospital. The medical history was unremarkable except for diabetes mellitus and hypertension. The haemogram and urine tests were normal. The only pathology revealed in routine biochemistry tests was increased glucose level (164 mg/dL). The repeat USG performed in our hospital revealed a solid hypoechoic mass lesion approximately 4 cm in diameter closely adjacent to the right kidney. At Doppler ultrasonography, the tumour demonstrated intense vascularisation. An abdominal CT scan was performed to characterise the lesion. The CT scan revealed a 42Ã-39 mm mass lesion with regular contours adjacent to the right kidney. In the arterial phase, the tumour demonstrated intense enhancement and in the delayed phase the images showed washout (figure 1). The patient underwent surgery and after histopathological examination retroperitoneal haemangiopericytoma was diagnosed and no relapse or distant organ metastasis was detected throughout the 2-year follow-up.

Malignant fibrous histiocytoma in a patient presenting with urinary system symptoms.

Malignant fibrous histiocytoma is a rare tumor. It is most commonly seen in individuals between the fifth and seventh decades of life, in extremities, and less frequently in the retroperitoneum. Although its etiology is not clearly known, radiotherapy, chemical agents, previous history of surgery, trauma and fracture, and Hodgkin lymphoma have been blamed. Leiomyosarcoma, liposarcoma and rhabdomyosarcoma should be taken into account in differential diagnosis. It is seen on computed tomography as a mass lesion with irregular borders and density similar to that of the surrounding muscle tissue. Necrotic and hemorrhagic components in the mass are characterized as heterogeneous low density areas. Fluid-fluid levels can be detected by computed tomography and magnetic resonance imaging.