Olfactory Bulb Volume and Morphology Changes in COVID-19 Patients With Olfactory Disorders Using Magnetic Resonance Imaging.

OBJECTIVES: The aims of the study are to explore the morphological changes of olfactory bulb (OB) and olfactory sulcus in COVID-19 patients with associated olfactory dysfunction (OD) by measuring the OB volume (OBV) and olfactory sulcus depth (OSD) and to compare the measurement values with those of healthy individuals. METHODS: Between March 2020 and January 2022, 31 consecutive hospitalized patients with a diagnosis of COVID-19 with anosmia and hyposmia who underwent brain magnetic resonance imaging and 35 normosmic control individuals were retrospectively included in the study. Bilateral OBV and OSD were measured and shape of the OB was determined based on the consensus by a neuroradiologist and an otorrhynolaryngologist. RESULTS: The mean measurements for the right and the left sides for OBV (38 ± 8.5 and 37.1 ± 8.4, respectively) and OSD (7.4 ± 0.1 and 7.4 ± 1.0 mm, respectively) were significantly lower in COVID-19 patients with OD than those in control group (for the right and the left sides mean OBV 56.3 ± 17.1 and 49.1 ± 13.5, respectively, and mean OSD 9.6 ± 0.8 and 9.4 ± 0.8 mm, respectively). Abnormally shaped OB (lobulated, rectangular, or atrophic) were higher in patient group than those of controls.For the optimal cutoff values, OBV showed sensitivity and specificity values of 90.32% and, 57.14%, for the right, and 87.1% and 62.86% for the left side, respectively (area under the curve, 0.819 and 0.780). Olfactory sulcus depth showed sensitivity and specificity values of 90.32% and 94.29%, for the right, and 96.77% and 85.71%, for the left side, respectively (area under the curve, 0.960 and 0.944). CONCLUSIONS: Decrease in OBV and OSD measurements in COVID-19 patients with OD at the early chronic stage of the disease supports direct damage to olfactory neuronal pathways and may be used to monitor olfactory nerve renewal while returning back to normal function.

The effects of breast reduction with superomedial and inferior pedicle techniques on radiological breast imaging.

BACKGROUND: Several breast reduction techniques have been introduced, and the reliability of these techniques has been demonstrated in clinical practice. However, it is still controversial how patients should be evaluated radiologically both preoperative and postoperative. This study aims to compare the radiological findings seen following reduction mammoplasty with two different techniques (inferior pedicle and superomedial pedicle), in connection with the surgical steps. METHODS: Medical records of 141 patients and a total of 278 breasts who underwent breast reduction with the diagnosis of macromastia were retrospectively analyzed. Demographic and operative data such as age, type of pedicle, preoperative and postoperative nipple-areola complex (NAC) position, and NAC transfer distance were recorded. Radiological evaluation was performed by two radiologists experienced in breast imaging by reinterpreting preoperative and postoperative mammography images. RESULTS: The rate of postoperative structural distortion (p < 0.001), thickened areola (p = 0.011), and retroareolar fibrotic band (p < 0.001) were observed to be significantly higher in the superomedial group. The risk of fat necrosis increases as the NAC transfer distance increases and a value of >9.5 cm in the NAC transfer distance can be considered as the cutoff value in terms of fat necrosis development, especially in those using superomedial pedicle technique. CONCLUSION: Surgical technique-specific benign radiological changes occur following reduction mammoplasty. However, these changes do not significantly affect the Breast imaging, reporting, and data system category. The localization of fat necrosis differs depending on the surgical technique, and the risk of fat necrosis increases as the NAC transfer distance increases, especially in those who have undergone superomedial pedicle breast reduction surgery.

Multiple perineural cysts in the cervical, thoracic, and lumbar vertebrae of a mature individual.

A 54-year-old female patient was admitted to our outpatient clinic with back and low back pain. There were no remarkable physical or neurological findings in the two-year follow-up period of the patient. There were 39 lesions at 17 levels (mean diameter: 5.93±2.77 [range, 1.00 to 12.2] mm) in entire vertebra in magnetic resonance imaging and more than one perineural cysts were observed adjacent to the same nerve root at several vertebrae levels. In this patient, conservative treatment was preferred.

Basal Serum Neurokinin B Levels in Differentiating Idiopathic Central Precocious Puberty from Premature Thelarche.

OBJECTIVE: To find out the diagnostic role of kisspeptin and neurokinin B in idiopathic central precocious puberty (ICPP) and premature thelarche (PT). METHODS: The girls who presented with early breast development before the age of 8 years were evaluated. Patients with intracranial pathologies were excluded. Basal and stimulated follicle-stimulating hormone/luteinizing hormone (LH) levels and basal neurokinin B/kisspeptin levels were measured. Patients who had peak value of LH >5 mIU/mL and a bone age (BA)/chronological age (CA) ratio >1.1 were diagnosed as central precocious puberty (CPP), while cases who did not meet these criteria were diagnosed as PT. Healthy age-matched prepubertal girls were included as the control group. RESULTS: The study group contained 25 girls with ICPP (7±0.8 years), 35 girls with PT (6.8±0.7 years), and 30 controls (6.7±0.7 years). Basal serum kisspeptin and neurokinin B levels were 2.36±0.47 ng/mL and 2.61±0.32 ng/mL, respectively in the ICPP group, 2.23±0.43 ng/mL and 2.24±0.23 ng/mL, respectively in the PT group, and 1.92±0.33 ng/mL and 2.03±0.24 ng/mL, respectively in the controls. Both kisspeptin and neurokinin B levels were higher in the ICPP and PT groups compared to controls (p<0.05). Moreover, basal neurokinin B level was different between ICPP and PT groups (p<0.01). A serum neurokinin B level of 2.42 ng/mL provided the most appropriate level to differentiate ICPP from PT, with a sensitivity of 84% and specificity of 77.1%. CONCLUSION: Differentiation of CPP from PT is sometime difficult, and there is a need for a simple method for the differential diagnosis. Our results suggest that basal serum neurokinin B level can be used as an adjunctive parameter to differentiate ICCP from PT.

Serum anti-Müllerian hormone levels in euthyroid adolescent girls with Hashimoto's thyroiditis: relationship to antioxidant status.

OBJECTIVE: Free radical-mediated oxidative stress has been implicated in the etiopathogenesis of Hashimoto's thyroiditis (HT), which is the most common thyroid disorder in adolescents. HT requires lifelong thyroid surveillance, particularly in women of childbearing age to avoid adverse effects on reproductive function. The aims of this study were to investigate serum concentrations of anti-Müllerian hormone (AMH), a marker of ovarian reserve, in euthyroid adolescent girls with newly diagnosed HT and explore the relationships between AMH levels and biomarkers of antioxidant status. STUDY DESIGN: We recruited 57 non-obese (body mass index [BMI] Z-score<2) adolescent girls with newly diagnosed HT and 50 age- and BMI-matched healthy controls for this case-control study. All participants were euthyroid. Hormonal and metabolic parameters, serum levels of AMH, and antioxidant status [paraoxonase (PON) and arylesterase (ARE) activities] were assessed. RESULTS: Serum AMH levels were significantly higher and serum PON and ARE activities were significantly lower in adolescents with HT than in the controls (p<0.001 for all). No significant associations were detected between the AMH level and any of the clinical or biochemical parameters in the control group. Serum AMH levels were negatively correlated with PON (r=-0.435, p=0.001) and ARE (r=-0.422, p=0.001) activities in adolescents with HT. CONCLUSION: The AMH level was significantly higher while the PON and ARE activities were significantly lower in euthyroid adolescent girls with newly diagnosed HT.

Application of Diffusion-Weighted Imaging in the Detection of Active Sacroiliitis and the Comparison of Apparent Diffusion Coefficient and Relative Apparent Diffusion Coefficient Values.

OBJECTIVES: This study aims to evaluate the role of diffusion-weighted imaging in detection of active sacroiliitis and compare the apparent diffusion coefficient (ADC) and normalized relative ADC (r-ADC) values by using vertebra and iliac wings as reference organs. PATIENTS AND METHODS: The study included 56 patients (26 males, 30 females; mean age 37.7±10.1 years; range 18 to 66 years) with chronic back pain and without history of sacroiliitis who underwent magnetic resonance imaging. T2-weighted spectral presaturation with inversion recovery, contrast-enhanced T1-weighted spectral presaturation with inversion recovery, and diffusion-weighted (b values: 0 and 600 s/mm2) images were obtained. All images were evaluated by two different radiologists for interobserver variability. All individuals were grouped in either mechanical low back pain (control group) or active sacroilitis (disease group) groups according to the presence or absence of MRI findings of active sacroilitis. ADC values of both surfaces were measured from normal and affected areas of joints. Also, ADC values of L5 vertebra and iliac wings were measured as reference organs to calculate r-ADC values. RESULTS: Mean ADC and r-ADC values measured from lesions were significantly higher than that of normal appearing bone marrow areas in both patients with mechanical low back pain (n=17) and active sacroiliitis (n=39). Both ADC values and r-ADC values could differentiate active lesions from normal appearing bone marrow areas as well as contrast-enhanced T1-weighted images. According to r-ADC values calculated with the L5 vertebra, unaffected portions of bone marrow areas in patients with sacroiliitis were normalized whereas r-ADC remained higher than normal in affected portions of the bones. CONCLUSION: Diffusion-weighted imaging is a fast, sensitive magnetic resonance imaging sequence in detection of active sacroiliitis. It does not require contrast agent and can be safely used as an adjunct to conventional magnetic resonance images. r-ADC is also highly sensitive in detecting active sacroiliitis and may be used as an alternative to standard ADC measurements for the demonstration of inflammation. It helps eliminate individual bone marrow differences by using patients' own normal bone marrow measurements and increases diagnostic accuracy.

Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis.

OBJECTIVE: Purpose of this study is to assess sonographic changes and clinical response in different subgroups of Baker's cyst patients with knee osteoarthritis after a single session of ultrasound-guided percutaneous aspiration and corticosteroid injection. MATERIALS AND METHODS: Thirty-two knee osteoarthritis patients (46-85 years, mean 58.97±9.88) with symptomatic Baker's cyst diagnosed at ultrasonography were included in the study. To determine the grade of the symptoms, Visual Analogue Scale was applied. The patients were grouped in two, as simple (n=24) and complex (n=8) Baker's cyst. Thirty-two ultrasound-guided cyst aspirations concomitant 1 ml betamethasone injection (24 simple, 8 complex subgroups) were performed. Patients were followed clinically as well as via ultrasonography for 6 months after procedures. RESULTS: A significant decrease in volume of the Baker's cysts after percutaneous treatment was accompanied by a significant clinical improvement. Moreover, the volume reduction of Baker's cyst after the treatment was significantly correlated with the clinical improvement (Pearson correlation coefficient=0.542, p=0.001). All 6 Baker's cysts relapsed at ultrasonography were complex type. Furthermore, a comparison of patients with simple Baker's cysts and those with complex Baker's cysts demonstrated no significant change in Visual Analogue Scale scores between two groups (p=0.061, Mann-Whitney U). No complications (minor or major) occurred secondary to percutaneous treatment. CONCLUSION: Baker's cysts can be grouped as simple and complex groups via ultrasonography prior to the treatment. Cyst aspiration with ultrasound-guided corticosteroid injection yields clinical improvement and cyst volume reduction in all subgroups of patients with Baker's cyst secondary to knee osteoarthritis.