Does Neutrophil-Lymphocyte Ratio Correlate with the Improvement of Hepatosteatosis after Laparoscopic Sleeve Gastrectomy?

INTRODUCTION: Obesity is a disease that shortens life expectancy and predisposes to many diseases such as severe hepatosteatosis. Hepatosteatosis is characterized by inflammatory infiltration of the portal space. Bariatric surgery has improvement effect on hepatosteatosis and degree of inflammation. Laparoscopic sleeve gastrectomy is an effective and most common therapeutic option for obesity. Neutrophil-lymphocyte ratio is a parameter associated with inflammatory disease. This study aimed to investigate if there is any correlation between improvements in hepatosteatosis and biochemical parameters especially neutrophil-lymphocyte ratio and ultrasonographic findings 1 year after the laparoscopic sleeve gastrectomy. METHODS: The files of 66 patients who underwent laparoscopic sleeve gastrectomy between May 2017 and April 2020 were retrospectively reviewed. Preoperative and postoperative 1-year demographic data, biochemical and inflammatory parameters, and ultrasonographic reports of the liver were reviewed. RESULTS: A statistically significant improvement in hepatosteatosis was demonstrated by ultrasonography 1 year after laparoscopic sleeve gastrectomy. A significant decrease was also observed in neutrophil-lymphocyte ratio. No correlation was found between the decrease of neutrophil-lymphocyte ratio and improvement in hepatosteatosis. There was also significant difference between the preoperative and postoperative BMI, biochemical and inflammatory parameters. CONCLUSION: However, we found laparoscopic sleeve gastrectomy is associated with significant improvement in hepatosteatosis and inflammatory parameters; no correlation between the improvement in hepatosteatosis and NLR was seen at 1 year.

Diffusion-Weighted Imaging of Brain Metastasis: Correlation of MRI Parameters with Histologic Type.

AIM: To compare the diffusion properties of brain metastases as imaging biomarkers in various types of tumours, to determine their histology and origin. MATERIAL AND METHODS: Magnetic Resonance Imaging (MRI) and diffusion-weighted imaging (DWI) were used to retrospectively study the data of 143 patients suffering from brain metastases. Four categories of primary tumours with metastases to the brain were included: lung carcinoma (n=102, 71.3%); breast carcinoma (n=27, 18.8%); colon carcinoma (n=8, 5.6%); and others (n=6, 4.2%). The Apparent Diffusion Coefficient (ADCmin ) values, as well as the normalised ADC ratio (nADC), were determined. The lesions on the DWI were categorised as follows: type 1, with negative findings on DWI; type 2, which were isointense with the normal cortical grey matter; type 3, which were hyperintense compared to the normal cortical grey matter. RESULTS: The diffusion type, mean ADCmin, and mean nADC showed statistically significant differences in different types of metastases. In the subgroup analysis, it was found that type 3 was the diffusion type found most extensively in the brain metastases of small cell carcinoma (SCLC) (n=52, 65.8%, p < 0.000). Furthermore, the mean ADCmin and nADC values were the least for the brain metastases of the SCLC (552.0 ± 134.2 and nADC = 0.8 ± 0.1, p < 0.000, respectively). The value of the mean ADCmin was low in the human epidermal growth factor receptor 2 (HER-2) negative groups than in the HER-2 positive groups at 786.8 ± 299.1 vs 844.8 ± 141.3 (p < 0.006). CONCLUSION: Our findings indicated that there is a correlation between diffusion parameters as imaging biomarkers of the solid component of brain metastases of primary tumours and the tumour histology.

The Mitochondrial DNA Control Region Might Have Useful Diagnostic and Prognostic Biomarkers for Thyroid Tumors.

The literature suggests that mitochondrial DNA (mtDNA) defects are associated with a large number of diseases including cancers. The role of mtDNA variations in thyroid cancer is a highly controversial topic. Therefore, we investigated the role of mt-DNA control region (CR) variations in thyroid tumor progression and the influence of mtDNA haplogroups on susceptibility to thyroid tumors. For this purpose, in total, 108 hot thyroid nodules (HTNs), 95 cold thyroid nodules (CTNs), 48 papillary thyroid carcinoma (PTC) samples with their surrounding tissues and 104 healthy control subjects' blood samples were screened for all mtDNA CR variations using Sanger sequencing. We found that MtDNA haplogroup U was significantly associated with susceptibility to benign thyroid entities. In addition, eight single nucleotide polymorphisms (SNPs) (T146C, G185A, C194T, C295T, G16129A, T16304C, A16343G and T16362C) in the mtDNA CR were associated with the occurrence of benign and malign thyroid nodules in the Turkish population. As compared with samples taken from a healthy Turkish population and HTNs, the frequency of C7 repeats in D310 polycytosine sequence was found to be higher in CTNs and the PTC samples. In addition, the frequency of somatic mutations in mtMSI regions including T16189C and D514 CA dinucleotide repeats were found to be higher in PTC samples than benign thyroid nodules. Conversely, the frequency of somatic mutations in D310 was found to be higher in HTNs than CTNs and PTCs. In conclusion, mtDNA D310 instability does not play a role in the tumorigenesis of PTC but the results indicate that it might be used as a diagnostic clonal expansion biomarker for premalignant thyroid tumor cells. In addition, D514 CA instability might be considered as a prognostic biomarker for benign to malign transformation in thyroid tumors.

Vaccine-induced myositis with intramuscular sterile abscess formation: MRI and ultrasound findings.

Although limb swelling is a well-known complication of vaccination, its rarity and wide band of differential diagnosis of limb swelling make it a diagnostic challenge. In this case report, we describe three cases of vaccine-induced myositis with intramuscular sterile abscess formation in patients with limb swelling and their magnetic resonance imaging and ultrasonography findings. Both radiologists and clinicians should be familiar with this rare entity, its clinical and imaging spectrum, and follow-up strategies.

Thrombolytic treatment (alteplase; rt-Pa) in acute massive pulmonary embolism and cardiopulmonary arrest.

Patients with pulmonary thromboembolism (PE) often decompensate suddenly, and once hemodynamic compromise has developed, mortality is extremely high. Currently, thrombolytic therapy for PE is still controversial. We retrospectively evaluated 34 patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease characteristics of patients who received thrombolytic treatment were retrospectively analyzed. The female to male ratio was 19/15 and the mean age was 63.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax computed tomography with echocardiography (32.4%). Twenty-two (64.7%) patients went into the cardiopulmonary arrest due to massive PE and 17 (50%) patients recovered without sequelae. Eleven (32.4%) patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. Alteplase (recombinant tissue plasminogen activator [rt-PA]) was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to rt-PA treatment complications. In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE. This thrombolytic treatment was not associated with any fatal hemorrhage complication. If there is any sign of acute PE, echocardiography should be used during cardiopulmonary arrest/instability. Alteplase should be given to patients with suspected massive PE.

Stroke in early childhood due to homocystinuria.

A previously healthy girl, age 3 years 9 months, presented with right-sided hemiparesis and seizures. Ischemic infarction was confirmed through magnetic resonance imaging and magnetic resonance angiography. Extensive evaluation to discover the underlying etiologies and risk factors predisposing this patient to stroke included coagulation defects, cardiac anomalies, congenital inborn metabolism deficiency, and infections and trauma. Based on the clinical and laboratory results, a diagnosis of homocystinuria was made. Homocystinuria is an inherited disorder that affects the metabolism of the amino acid methionine. Although homocystinuria is usually associated with ischemic strokes, the sudden onset of stroke as the initial clinical presentation of homocystinuria is very rare in early childhood. Based on this case, however, metabolic screening for hyperhomocystinemia is recommended in any child presenting with a stroke.

MRI of recurrent isolated cerebral Whipple's disease.

Whipple's disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipple's disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipple's disease in a 68-year-old man with atypical presentation and MRI findings.

Diffusion-weighted MR imaging of kidneys in patients with systemic lupus erythematosus: initial experience.

To evaluate kidney perfusion and diffusion in patients with systemic lupus erythematosus (SLE) and define any correlation between laboratory features of renal involvement and apparent diffusion coefficients (ADCs). We studied 35 patients with SLE and 30 healthy volunteers. Ten of the patients were diagnosed as having lupus nephritis. Transverse diffusion-weighted multisection echo-planar magnetic resonance imaging was created with the following diffusion gradient b values: 0, 111, 222, 333, 444, 556, 667, 778, 889, and 1,000 s/mm(2). Statistical analyses to compare ADCs of kidneys between patients in the study and control groups were done with the independent sample t test. The Pearson correlation analysis was used to evaluate the relation between the renal function variables and the ADCs. There was statistically significant difference between the ADC(low) values and the urine protein levels (P < 0.05) in the patients with SLE. Also, there was a significant correlation between the duration of nephritis and urine protein levels in the patients with SLE (P < 0.01). There was no statistically significant differences regarding ADCs, serum creatinine levels, and GFRs among patients with SLE and controls. Our patients had mild SLE and this might be the reason that no statistically significant differences were found between ADCs, and laboratory features of renal involvement among patients with SLE and controls. Larger series and more diffusion experience may be valuable for future studies.

Sinonasal schwannoma of the middle turbinate.

Paranasal schwannomas are uncommon lesions, representing less than 4% of all head and neck schwannomas. They give rise to nonspecific symptoms such as nasal obstruction, epistaxis, and anosmia. Imaging features are generally nonspecific. Here, we present the radiologic features of a benign schwannoma of the middle turbinate with dural invasion in a 71-year-old woman.

Extraperitoneal pelvic myolipoma.

Myolipoma is a very rare adipocytic tumor occurring most frequently in adults, and usually is located in the retroperitoneum or abdomen. It has been described in the retroperitoneum, spinal cord, orbita, breast, round ligament, subcutaneous tissue, pericardium, rectus sheath of the abdominal wall, and abdominal cavity with attachment to the abdominal wall. Most of these tumors are discovered incidentally and are large when discovered. Radiological findings are nonspecific due to the nonlipomatous component of the tumor. We present radiological findings of a large extraperitoneal pelvic myolipoma adjacent to the anterior abdominal wall, detected incidentally in an elderly woman with a presenting complaint of intractable hiccups.

Inner ear lipoma.

Intracranial lipomas are uncommon congenital malformations that are often asymptomatic. They are very rarely seen in the inner ear. There are a few case reports in the literature related to intravestibular lipoma. It was also defined in the internal auditory canal and the cerebellopontine angle. We present here a case of an inner ear lipoma that diffusely infiltrated the cochlea, vestibule and the semicircular canals. To our knowledge, this is the first reported case in the literature.

Acute sarcoid myositis with unusual radiologic findings.

A 59-year-old man presented with bilateral calf pain and swelling for two weeks. Ultrasound and magnetic resonance imaging examination showed multiple bilateral, nodular, and spindle- shaped lesions in the gastrocnemius and soleus muscles. On physical examination, hyperpigmented, papular lesions were noticed; biopsy of the skin of his right elbow showed granulomatous inflammation. His angiotensin converting enzyme level was markedly elevated. Computed tomography showed diffuse interstitial thickening, miliary nodules, and traction bronchiectases throughout the lung parenchyma. Ophthalmologic examination showed uveitis in his left eye. Based on the lung, eye, and skin findings, a clinical diagnosis of sarcoidosis was made. After two months of corticosteroid treatment, his muscle lesions largely resolved.

MRI features of posterior reversible encephalopathy syndrome in 33 patients.

BACKGROUND AND PURPOSE: We report the clinical and radiological features of posterior reversible encephalopathy and compare our findings to the literature. METHODS: The brain magnetic resonance imaging and clinical records of 33 patients were retrospectively evaluated. Twenty-four patients had follow-up imaging, which confirmed the reversibility of the lesions; 9 patients were clinically followed and recovered. The clinical records were analyzed for the age, sex, gender, underlying etiology, and clinical symptoms. MR images were evaluated for the distribution of the lesions, contrast enhancement and diffusion-weighted-imaging (DWI) features, reversibility, and complications. RESULTS: The most commonly involved localizations were frontal lobe in 51.5%, parietal lobe in 84.8%, occipital lobe in 72.7%, temporal lobe in 33.3%, and cerebellum in 33.3%. Nineteen patients had DWI, which showed vasogenic edema in 17 and cytotoxic edema in 2. Sixteen patients had contrast-enhanced images; 4 of them showed focal enhancement. Nine patients had the complication of hemorrhage. CONCLUSION: The involvement of different localizations formerly known as atypical is now commonly encountered. Intravenous contrast administration may be of use to demonstrate focal enhancement and exclude other diseases in the differential. DWI is essential to distinguish the type of edema. Repeat imaging including DWI should be performed to follow the response to therapy.

Diffusion-weighted MRI of the kidneys in patients with familial Mediterranean fever: initial experience.

PURPOSE: To evaluate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of renal function in patients with familial Mediterranean fever (FMF). MATERIALS AND METHODS: Thirty healthy volunteers who had no history of renal disease, hypertension or vascular disease and 60 patients with FMF were included in the study. Transverse diffusion-weighted multisection echo-planar MRI was performed with the following diffusion gradient b values: 0, 111, 222, 333, 444, 556, 667, 778, 889 and 1000 s/mm(2). The apparent diffusion coefficient (ADC) values, urine protein and serum creatinine levels, and glomerular filtration rates of the healthy volunteers, patients with renal involvement, and patients without were compared by using ANOVA test. ADCs of the kidneys were calculated separately for low (ADC(low); b = 0, 111, 222, 333 s/mm(2)), average (ADC(avg); of all b values), and high (ADC(high); b = 778, 889, 1000 s/mm(2)) b values to enable the differentiation of the relative influence of perfusion fraction and true diffusion. ADC(high) reflects almost only diffusion, whereas ADC(low) is composed of both diffusion and perfusion. RESULTS: There was statistically significant difference between ADC(low) values of the FMF patients with renal involvement and the control group (P < 0.05). Negative correlation was found between the duration of disease and ADC(low) values of the kidneys (r = -0.223, P = 0.087). CONCLUSION: DW-MRI of the kidneys might allow early detection of the renal changes in patients with FMF. This might prevent the progression of disease by giving proper medical treatment. Further studies with larger numbers of FMF patients and more experience on MRI technique are required to help define more conclusively the precise role of DW imaging in detection of renal changes.

CT of double descending thoracic aorta in an adult female.

Persistent double dorsal aorta is a rare congenital anomaly of the descending aorta. It is an anomaly with two variants. The first type is characterized by complete separation of two dorsal aortae. The second type is a double-lumen descending aorta with a central dividing septum from the level just below the ductal ligament to the aortic bifurcation. We present a completely separated double dorsal aorta with a narrower right segment and the main left segment between the 6th and 10th thoracic vertebrae.

MDCT of biliary cysts in children with biliary atresia: clinical associations and pathologic correlations.

PURPOSE: To evaluate the association of biliary cyst formation with cholangitis, portoenterostomy, biochemical abnormalities, using multidetector computed tomography (MDCT) and pathologic findings of end-stage liver disease. MATERIALS AND METHODS: We retrospectively reviewed the 42 MCDT studies, clinical history and laboratory findings of 36 children with biliary atresia. RESULTS: Biliary cysts were detected in 58% of the patients on MDCT images. The cysts were not associated with cholangitis, portoenterostomy surgery, or biochemical abnormality. Hepatic artery anomaly was also common in our series (25%) and more common in patients with biliary cysts which was statistically significant (P < 0.05). Eighteen livers were available for pathologic examination. The only statistically significant finding between the patients with and without biliary cysts were biliary epithelial damage and inflammatory reaction around the cysts which were common in the patients with biliary cysts (P < 0.05). CONCLUSION: The damage to the bile duct epithelium and inflammatory reaction around the biliary epithelium support the theory of obstruction and bile leaks in the etiogenesis of biliary cysts. This is the first report of the association between hepatic artery variations and the biliary cysts; this may be important in pretransplant evaluation.

MRI of central nervous system abnormalities in childhood leukemia.

PURPOSE: To document the imaging abnormalities seen in the central nervous system (CNS) in childhood leukemia or as complications of its treatment. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) of 15 children with neurologic complications of leukemia or its treatment were reviewed retrospectively. The first group consisted of patients with CNS abnormalities detected prior to or during treatment, or within three months after completion of treatment. Patients with CNS complications detected by MRI three months following completion of treatment were included in the second group. RESULTS: Among the 15 children, six had two or more different CNS abnormalities. The imaging abnormalities seen in 12 patients prior to or during treatment, or within three months after completion of treatment included orbital, temporal, cerebellopontine angle, and spinal chloroma; bilateral subdural hematoma in the subacute stage; multifocal intraparenchymal hemorrhage; bilateral retinal hemorrhage and detachment; hematoma in the pons and mesencephalon; PRES (posterior reversible leukoencephalopathy syndrome); bilateral leukemic infiltration of the 3(rd), left 7(th), and 8(th) cranial nerves; and meningeal leukemia. Three months after completion of treatment, three patients had CNS complications including radiation necrosis and secondary brain tumor, osteomyelitis of the L3 vertebra, and meningeal leukemia. CONCLUSION: The wide spectrum of CNS abnormalities that occur during and after treatment for leukemia is related to leukemia and to the treatment method. Because many neurologic complications of leukemia are treatable, early diagnosis is essential.

Multidetector CT findings of spontaneous rupture of hepatic adenoma in a patient with hepatic adenomatosis.

Hepatic adenomatosis (HA) is characterized by more than 10 adenomas in the liver, frequently scattered within both lobes. The potential for spontaneous bleeding, rupture, and malignant transformation is known. In HA, tumors show hypervascularization on arterial angiography, computed tomography (CT), and magnetic resonance imaging. We report the case of a 32-year-old woman who presented with a large intraparenchymal and subcapsular hematoma in the liver, and an underlying large adenoma with atypical radiologic characteristics detected with multidetector CT imaging. On follow-up CT examination, a large adenoma was clearly visualized at the site of the previous hematoma.

MRI findings in renal transplant recipients with hip and knee pain.

PURPOSE: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. MATERIALS AND METHODS: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. RESULTS: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. CONCLUSION: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be the second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.