Tracking down the footprints of bad paternal relationships in dissociative disorders: A diffusion tensor imaging study.

Preclinical studies indicate that stress early in life can cause long-term alterations in brain development. Studies have shown alterations in the brain functions of patients after experiencing trauma. Our aim is to examine whether the integrity of white matter tracts might be affected in dissociative disorder (DD) patients. A total of 15 DD patients and 15 healthy controls were studied, with the groups matched by age and gender. Diffusion-weighted echoplanar brain images were obtained using a 1.5 Tesla magnetic resonance imaging scanner. Regions of interest were manually placed on directional maps based on principal anisotropy. Apparent diffusion coefficient and fractional anisotropy (FA) values of white matter were measured bilaterally in the anterior corona radiata (ACR) and by diffusion tensor imaging in the genu and splenium of the corpus callosum. Significantly lower FA values were observed in the right ACR of DD patients versus healthy individuals. We also found an association between bad paternal relationships and lower FA in the genu of the corpus callosum in female patients. Alterations in the right ACR suggest that diffusion anisotropy measurement can be used as a quantitative biomarker for DD. Paternal relationships may also affect the brain's microstructure in women with DD.

Microstructural Changes of Anterior Corona Radiata in Bipolar Depression.

OBJECTIVE: In bipolar disorder, dysregulation of mood may result from white matter abnormalities that change fiber tract length and fiber density. There are few studies evaluating the white matter microstructural changes in bipolar I patients (BD) with depressive episodes. The present study aimed to evaluate anterior corona radiata in BD patients with depressive episode using Diffusion Tensor Imaging (DTI). METHODS: Twenty-one patients with bipolar depression and 19 healthy controls were investigated and groups were matched for age and gender. Diffusion-weighted echoplanar brain images (DW-EPI) were obtained using a 1.5 T MRI scanner. Regions of interest (ROIs) were manually placed on directional maps based on principal anisotropy. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of white matter were measured in the anterior corona radiata (ACR) bilaterally by diffusion tensor imaging. RESULTS: There was not a significant difference between groups of age and gender (p>0.05). Significantly lower FA was observed in bilateral ACR in bipolar patients with depression compared with healthy individuals. And there is significantly higher ADC values in the left frontal corona radiate in bipolar patients. CONCLUSION: White matter abnormalities can be detected in patients with BD using DTI. The neuropathology of these abnormalities is unclear, but neuronal and axonal loss, myelin abnormalities and reduced white matter fiber density are likely to be relevant.

Joubert syndrome: the clinical and radiological findings.

Joubert syndrome is a rare disease characterised by clinical and radiological findings. Among the classic clinical findings of JS are hypotonia, ataxia, mental-motor retardation, respiratory and opthalmological findings. The paediatric cases included in the study comprised nine patients. There was familial consanguinty in seven cases. Clinically, all cases had mental-motor retardation and hypotonia. Episodic hyperpnoea attacks were observed in one case. Facial dysmorphism was the most common additional systemic anomaly and four cases had additional opthalmic findings. Brain MRI examination revealed that all cases had molar tooth sign, bat-wing appearance and vermian cleft. The majority of cases also had vermian hypoplasia. Cerebellar folial disorganisation was observed in approxiamtely half of the cases. Three cases had corpus callosum anomaly and atretic occipital encephalocoele. No pathology was determined in other organs. This study aimed to evaluate the clinical and radiological findings of 9 patients diagnosed with Joubert syndrome.

Diffusion-weighted MRI of the testes in patients with varicocele: a preliminary study.

OBJECTIVE: This preliminary study aimed to evaluate changes in apparent diffusion coefficient (ADC) values of the testes in patients presenting with varicocele. SUBJECTS AND METHODS: This cross-sectional study included 25 consecutively recruited patients with varicocele and 25 healthy control volunteers. The ADC values were measured in all participants. Kolmogorov-Smirnov tests were used to test the normality of the data distributions, and the data were expressed as arithmetic means and SDs. A one-way analysis of variance with a post hoc Bonferroni test was used to analyze normally distributed continuous data. Independent sample Student t tests were used to compare continuous variables between two groups. Furthermore, a Pearson correlation coefficient analysis was used to examine the association of venous diameters with mean ADC values in patients with varicocele. A two-sided p value < 0.05 was considered statistically significant. Sensitivities, specificities, and areas under the curve were calculated for the ADC values. RESULTS: The ADC values associated with the ipsilateral testicular parenchyma of patients with varicocele were found to be lower than those of healthy volunteers. Moreover, the ADC values of the contralateral testicular parenchyma in patients with varicocele were also lower than those of healthy volunteers. The sensitivity and specificity of ADC values were 90% and 96%, respectively, for patients with varicocele and 89.5% and 96% for healthy volunteers. The mean ADC values were significantly negatively correlated with venous diameter. CONCLUSION: The measurement of testicular ADC values may be used as a diagnostic indicator in the detection of testicular fibrosis.

Efficacy of diffusion-weighted magnetic resonance imaging in follow-up patients treated with open partial cystectomy of liver hydatid cysts.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy of DWI in differentiation of patients with residual cavity and type 1 hydatid cyst (HC) in the liver. METHODS: 32 patients were included. 12 of these patients had type 1 HC and the remainders (n = 20) had postoperative residual cavities. In all patients, axial T2-weighted and DWI images were obtained. An apparent diffusion coefficient (ADC) map of the images was automatically generated and the ADC values were measured on this map for all patients. Mann-Whitney U test was used for comparison of continuous variables between two groups. RESULTS: The mean diameters of type 1 hydatid cyst and residual cavity groups were 83.42 mm, 49.30 mm, respectively (P = 0.001). There were no significant differences in gender and age between the groups (both P > 0.05). The mean ADC values of type 1 hydatid cyst and residual cavity groups were 2.58 ± 0.13 × 10(-3) s/mm(2), 2.58 ± 0.16 × 10(-3) s/mm(2), respectively (P = 0.953). CONCLUSION: DWI might not be suitable to differentiate the postoperative residual cavity from the type 1 hydatid cyst in the liver due to similarity of ADC values between postoperative residual cavity and type 1 hydatid cyst.

The use of sonoelastographic elasticity index to differentiate benign and malignant thyroid nodules.

PURPOSE: The aim of this study is to evaluate the elasticity index of thyroid nodules by sonoelastographic imaging, and to determine the cut-off value to distinguish malignant nodules from benign nodules with optimum sensitivity and specificity. MATERIALS AND METHODS: Fine needle aspiration biopsy (FNAB) of 84 cases were evaluated with B-mode US and Sonoelastography (USE) preoperatively. The elasticity score (ELX 2/1) index of the nodules were calculated. Seventy-three patients with diagnostic biopsy results were included in this study. RESULTS: According to the FNAB results, 9 (12 %) nodules were malignant, 64 (88 %) nodules were benign. All malignant nodules were papillary carcinoma, and their diagnosis was confirmed with thyroidectomy. The ELX 2/1 index of all malignant nodules was higher than 1.65. The ELX 2/1 index of 45 (70.3 %) benign nodules was lower than 1.65 whereas the ELX 2/1 index of 19 (29.7 %) benign nodules was higher than 1.65. Using an ELX 2/1 index cut-off value of 1.65 led to a sensitivity of 100 % and a specificity of 71 % in detecting papillary thyroid carcinomas. CONCLUSIONS: Assessing the ELX 2/1 index as a screening test and deciding on FNAB accordingly, in addition to gray-scale ultrasound findings of the nodules, will be beneficial in order to prevent unnecessary biopsies.

The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis.

This study aimed to evaluate the changes in spleen and liver diffusion-weighted magnetic resonance imaging (DWI) in chronic viral hepatitis patients. The study comprised 47 patients and 30 healthy volunteers. DWIs were obtained. Apparent Diffusion Coefficient (ADC) measurements were made by transferring the images to the workstation. The measurements of value b 1000 were made from a total of five points of the liver and three points of the spleen. Liver biopsy was performed on the 47 patients. The fibrosis stages of the patients were defined according to the METAVIR scoring system. Student's t-test was used in the comparison of mean ages, liver and spleen ADC values between the patient and the control group. Kruskal-Wallis followed by Mann-Whitney U Test with Bonferroni adjustment was performed in the comparison of mean ADC values of the patients at different stages and the control group. A statistically significant difference was determined between the patient and control group in respect of liver and spleen mean ADC values (P<0.05). F3 group showed a significant difference compared to control and F1 and F4 group showed a significant difference compared to control, F1, F2 and F3 group in terms of the mean liver ADC value (P<0.01). F3 and F4 group showed a significant difference compared to control and F1 group in terms of the mean spleen ADC value (P<0.01). As a result we believe that the measurement of liver and spleen ADC values may be an indicator in the determination of the level of fibrosis.

Association of parity with osteoprotegerin levels and atherosclerosis.

PURPOSE: Association of serum osteoprotegerin (OPG) levels and cardiovascular disorders has been shown previously. The aim of this observational study was to investigate the relationship between parity, OPG and carotid intima-media thickness (CIMT) in premenopausal women. METHODS: A total of 128 women (mean age ± SD, 37.8 ± 4.7 years) were divided into three group according to parity [1-3 as group 1 (n = 41), 4-6 as group 2 (n = 55) and ≥7 as group 3 (n = 32)]. Serum OPG was measured and CIMT was evaluated. RESULTS: Both serum OPG levels and CIMT tended to increase with advancing parity; OPG level was significantly higher in group 3 than in group 1 (p = 0.013) and CIMT was significantly higher in group 2 and group 3 than in group 1 (p < 0.001 for both). In correlation analyses, there were significant correlations between all three parameters. CONCLUSIONS: Our results revealed that there was an increased risk of cardiovascular disease in women with multiparity. Significant association of OPG with CIMT suggested that OPG might play a role in the pathogenesis of parity-induced atherosclerosis.

Diffusion-weighted imaging of patients with neonatal bilirubin encephalopathy.

PURPOSE: The aim of the study is to evaluate neonatal bilirubin encephalopathy in the acute period by the DWI. MATERIALS AND METHODS: Thirty newborn babies with hyperbilirubinemia at the gestational age of 38-40 weeks, diagnosed with acute neonatal bilirubin encephalopathy as a result of clinical findings were included in the study, and a further 24 newborn babies, whose ages, weights and gestational ages were equalized, were regarded as a control group. DWI was performed on both patient and control groups. RESULTS: When DWI apparent diffusion coefficients (ADC) of both neonatal bilirubin encephalopathy patients and the control group were compared, ACD values of neonatal bilirubin encephalopathy patients were found to be statistically significantly highly compared to that of the control group (p < 0.001). There was a significant correlation between bilirubin values and DWI findings (r = 0.41, p < 0.05). CONCLUSION: The ADC measurement could be a promising parameter in detecting neonatal bilirubin encephalopathy.

The role of diffusion-weighted magnetic resonance imaging in the classification of hepatic hydatid cysts.

The aim of the study was to classify different types of hepatic hydatid cysts (HHCs) by measuring the mean apparent diffusion coefficient (ADC) using diffusion-weighted magnetic resonance imaging (DWI). This prospective study comprised 44 patients. The 44 HHCs were classified using Gharbi ultrasonographic classification (GUC) and then T2WIs and DWIs were obtained. The ADC values were measured of the hydatid cyst (HC) subtypes. The distribution of the ADC values in the cyst groups was compared using the Kruskal-Wallis test for multi groups and the Mann-Whitney U test for paired groups. To evaluate the efficacy of ADC values in cyst diagnosis, receiver operating characteristic (ROC) analysis was performed. According to the GUC, there were 15 type 1, 11 type 2, 7 type 3, 5 type 4 and 6 type 5 HHCs. According to the ADC values in the paired comparisons, while types 1, 2 and 5 HCs were statistically differentiated from all other groups except the type 3 group, the type 4 group was differentiated from all other groups and the type 3 group was only differentiated from the type 4 group. When two groups were formed from the HHC subtypes with types 1, 2, and 3 in one group and types 4 and 5 in the other, a statistically significant difference was determined in the mean ADC values of these new groups. In conclusion the measurement of ADC values can be considered a promising parameter as an alternative to ultrasonography in the determination of subtypes of HHCs.

Diffusion-weighted MRI of the testis in hydrocele: a pilot study.

OBJECTIVE: To investigate the effects of increased pressure due to the accumulated fluid around testis in hydrocele on testis diffusion and whether this effect (if any) is correlated with the amount of fluid and duration of hydrocele. PATIENTS AND METHOD: 49 patients with unilateral hydrocele were evaluated by magnetic resonance diffusion-weighted imaging. RESULTS: In the study group, while the apparent diffusion coefficient (ADC) values of the testicles with hydrocele differed significantly before and 3 months after the hydrocelectomy (p = 0.001), the ADC values of the testicles without hydrocele were not statistically different (p = 0.101). There was a significant negative correlation between the ADC values of the testicles with hydrocele and the amount of the liquid aspirated during the hydrocelectomy (r = -0.615, p = 0.001). There was no correlation between the ADC values of testis and the duration of hydrocele (r = -287, p = 0.156). This is supported by the findings of the present study of reduced ADC values of testis, meaning reduced diffusion of the testis, with an increasing amount of fluid. CONCLUSION: The pressure of the fluid was suggested to show a mechanical effect that plays an important role in the dysfunction of the testis. The possible dysfunctions of the testicular tissue suggest that they may have a negative effect on fertility.

A rare case of petrous apex osteoma.

Osteomas are the most common tumours of the cranial vault and facial skeleton. Temporal bone osteoma is a rare entity. An osteoma arising from the petrous apex is extremely rare. We present a case of osteoma arising from the petrous apex followed by a discussion of the etiology, presentation, and radiologic findings.

Association of serum amyloid A with subclinical atherosclerosis in women with gestational diabetes.

The aim of our study was to evaluate serum amyloid A (SAA), an acute phase reactant, and carotid intima-media thickness (CIMT) as a valid predictor of atherosclerosis in women with gestational diabetes mellitus (GDM). Serum samples from 39 pregnant women with GDM and 25 healthy pregnant women were collected for the analysis of SAA. CIMT was measured in both groups to evaluate future atherosclerotic heart disease risk. The SAA level was measured with ELISA. The mean arterial blood pressure (MABP), CIMT and SAA levels were significantly higher in women with GDM compared with healthy pregnant controls (p = 0.033, p = 0.001 and p = 0.004, respectively). There were significant correlations between SAA and age, BMI, MABP, 50-g oral glucose tolerance test (OGTT), and A1c (p = 0.048, p = 0.037, p = 0.035, p = 0.042 and p = 0.048, respectively) and between CIMT and BMI, MABP, and 50-g OGTT, (p = 0.001, p = 0.004 and p < 0.001, respectively) in correlation analysis. Furthermore, there was a correlation between SAA and CIMT (p = 0.048). Increased SAA and CIMT values in GDM compared with healthy controls might indicate an increased risk of subclinical atherosclerosis and future atherosclerotic heart disease and the importance of inflammation in this process. These changes were associated with obesity, hypertension and glucose intolerance-related factors (BMI, MABP, and 50-g OGTT), which may be relevant to GDM pathophysiology.

Evaluation of the future atherosclerotic heart disease with oxidative stress and carotid artery intima media thickness in gestational diabetes mellitus.

BACKGROUND AND OBJECTIVE: In this study our aim was to evaluate paraoxonase (PON1) activity and free sulfhydryl groups (-SH) as antioxidative parameters and lipid hydroperoxide (LOOH) as oxidative parameter in the serum of women with gestational diabetes mellitus (GDM) and determine their relation with the degree of subclinical atherosclerosis. MATERIAL AND METHODS: Serum samples from 39 pregnant women complicated with GDM and 40 healthy pregnant women were collected for the analysis of oxidative markers. Common carotid artery intima media thickness (CIMT) was measured for both groups to assess future atherosclerotic heart disease risk. PON1 activity and -SH were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with a xylenol orange assay. RESULTS: CIMT and LOOH levels were significantly higher (p = 0.01, p < 0.001, respectively) in GDM group compared to controls, whereas PON1 and -SH levels were significantly lower (p < 0.001 for both). CIMT values were significantly correlated with body mass index (BMI), 50 g oral glucose tolerance test (OGTT), and mean arterial blood pressure (MABP) (p = 0.003, p = 0.02, and p = 0.03, respectively). However, there was no correlation between CIMT and oxidative markers. CONCLUSIONS: Increased levels of LOOH and decreased levels of PON1 and -SH showed disturbance of antioxidative mechanisms in GDM. These changes were associated with increased BMI and MABP which may be relevant to GDM pathophysiology. Furthermore, increased CIMT values in GDM compared to healthy controls designate increased risk of future atherosclerotic heart disease.

Impact of COPD exacerbation on cerebral blood flow.

We aimed to investigate the impact of chronic obstructive pulmonary disease (COPD) exacerbation on cerebral blood flow (CBF). In 21 COPD patients - in both exacerbation and stable phases -Doppler ultrasonographies of internal carotid artery (ICA) and vertebral artery (VA) were performed. There were significant differences in total, anterior and posterior CBF, ICA and VA flow volumes in exacerbated COPD compared to stable COPD. Total CBF was correlated with cross-sectional areas of left and right ICA, whereas independent predictor of total CBF was cross-sectional area of right ICA. Increased CBF might indicate cerebral autoregulation-mediated vasodilatation to overcome COPD exacerbation induced hypoxia.

Evaluation of carotid intima-media thickness, a marker of subclinical atherosclerosis, in children with cerebral palsy.

BACKGROUND: Respiratory and cardiovascular diseases are the most common causes of death in children with cerebral palsy. OBJECTIVE: To evaluate sonographic carotid intima-media thickness, an early marker of atherosclerosis, in children with cerebral palsy and in healthy controls. MATERIALS AND METHODS: One hundred children with cerebral palsy (65 boys), mean age 6.2 (SD, 2.1) years, and 35 age-matched and sex-matched healthy controls were included. Common carotid artery intima-media thickness was measured sonographically. Differences between patients and controls were evaluated with an independent samples t-test. RESULTS: Age, sex distribution and levels of serum lipids were comparable between patients and controls. Average, right and left carotid artery intima-media were thicker in patients compared with controls (mean ± SD, 0.61 ± 0.13 mm vs 0.40 ± 0.03 mm; 0.61 ± 0.14 mm vs 0.40 ± 0.03 mm; 0.61 ± 0.13 mm vs 0.40 ± 0.03 mm, respectively; all P < 0.001). CONCLUSION: Carotid intima-media is sonographically thicker in children with cerebral palsy compared with healthy controls, which may express an increased risk of atherosclerotic diseases.

Co-occurrence of diaphragmatic and serratus anterior muscle hydatidosis: an unusual localization.

BACKGROUND: With hydatid cyst, the skeletal muscles and diaphragm are rarely affected, and hepatic and pulmonary hydatid cysts are far more common. We report a case with an unusual localization of diaphragmatic and serratus muscle anterior hydatidosis that occurred simultaneously. CASE REPORT: A 37-year-old developmentally disabled woman presented to the Emergency Department (ED) of Harran University with tachycardia, tachypnea, and dyspnea. On pulmonary auscultation, breath sounds were decreased on the right side. A chest X-ray study revealed a radiopaque right hemithorax with a mediastinal shift and tracheal displacement. Thoracic computed tomography scan revealed a hydatid cyst in the serratus muscle anterior and cystic vesicles in the pleural cavity. The patient underwent chest drainage. During drainage, daughter vesicles within the pus were detected macroscopically. An elective thoracotomy was performed after hemodynamic stabilization of the patient. Postoperative chest X-ray study demonstrated that the lungs had re-expanded. The patient had no postoperative complications and was discharged with relief of all symptoms. CONCLUSION: Hydatid cyst should be considered, especially in endemic regions, in the differential diagnosis in the presence of a rare localization or unexpected clinical presentation. Surgical intervention is the appropriate approach for the treatment of hydatid cyst when there is concomitant intrathoracic involvement.