The Relationship between Quadriceps Thickness, Radiological Staging, and Clinical Parameters in Knee Osteoarthritis.

[Purpose] The aim of this study was to investigate the relationship between clinical parameters, radiological staging and evaluated ultrasound results of quadriceps muscle thickness in knee osteoarthritis. [Subjects] The current study comprised 75 patients (51 female, 24 male) with a mean age of 57.9±5.2 years (range 40-65 years) and a diagnosis of osteoarthritis in both knees. [Methods] Knee radiographs were evaluated according to the Kellgren-Lawrence grading system. Clinical evaluation performed with the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the 50-meter walking test, and the 10-step stair test. The thickness of the muscle layer of the quadriceps femoris (M. vastus intermedius and M. rectus femoris) was measured with high-resolution real-time ultrasonography. [Results] The results of this study showed a significant negative correlation between quadriceps thickness and age, duration of disease, stage of knee OA, and VAS, WOMAC, 50-m walking test, and 10-step stair test scores. [Conclusion] The evaluation of quadriceps muscle thickness with ultrasound can be considered a practical and economical method in the diagnosis and follow-up of knee osteoarthritis.

Eyelid myoclonia with absence seizures in a child with l-2 hydroxyglutaric aciduria: findings of magnetic resonance imaging.

l-2 hydroxyglutaric aciduria is a rare, autosomal recessively inherited metabolic disorder of organic acid metabolism. A 5-year-old boy presented with eyelid myoclonia with absences that proved difficult to control with first-line anticonvulsants. An electroencephalogram produced profoundly abnormal results, with generalized spike-and-wave discharges. The patient became seizure-free with a combination therapy of clonazepam, levetiracetam, and lamotrigine. Magnetic resonance imaging demonstrated subcortical white matter and basal ganglia alterations. Urinary organic acid analysis demonstrated increased excretion of l-2 hydroxyglutaric acid. Although rare, seizures can occur as a presenting sign of slowly progressing organic acidurias, e.g., l-2 hydroxyglutaric aciduria. Both eyelid myoclonia with absences and l-2 hydroxyglutaric aciduria comprise rare disorders. To our knowledge, this case report is the first of l-2 hydroxyglutaric aciduria presenting with symptomatic eyelid myoclonia with absences.

Prevalence of human cytomegalovirus co-infection in patients with chronic viral hepatitis B and C: a comparison of clinical and histological aspects.

BACKGROUND: Human cytomegalovirus (HCMV) is a common pathogen of severe disease in patients with impaired immune functions. Reactivation of HCMV in immunocompetent host is usually asymptomatic, but may deteriorate the prognosis of patient with chronic illness. OBJECTIVES: This study was conducted to detect HCMV infection in patients with chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections and to point out the effects of HCMV-HBV and HCMV-HCV co-infections on liver histology. STUDY DESIGN: Expression of HCMV DNA was determined in liver tissue biopsies by real-time quantitative polymerase chain reaction (qPCR) method. There were 44 chronic HBV, and 25 chronic HCV patients within the study group. Control group consisted of 36 patients with hepatologic malignancies. RESULTS: HCMV infection was demonstrated in 52.3% of chronic HBV, and 36% of chronic HCV patients. Although alanine aminotransferase (ALT) levels of HCMV-infected HBV patients were decreased slightly, they were increased in HCV patients. Histologic activity scores (necroinflammation and fibrosis) of HCMV-positive patients were higher than that of HCMV-negatives in both HBV and HCV groups. Intrahepatic HBV DNA or HCV RNA loads of the corresponding study groups were decreased in HCMV-infected patients. CONCLUSION: We conclude that HCMV infection is common in chronic HBV and HCV patients, who can be regarded as patients at high risk for HCMV disease. Though the histological changes were more marked in liver, replication of HBV and HCV were inhibited in HCMV-positive cases.

The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development.

OBJECTIVE: To determine the effects of fasting during the month of Ramadan on fetal development and maternal serum cortisol and lipid profile. METHODS: This study was performed in Obstetrics and Gynecology Department of Gaziantep University Hospital, between 23 September 2006 and 23 October 2006 (during the month of Ramadan). Thirty-six consecutive healthy women with uncomplicated pregnancies of 20 weeks or more, who were fasting during Ramadan, were included in the study group (group 1). The control group (group 2) consisted of 29 healthy pregnant women, who were not fasting during the study period. For evaluating Ramadan's effect on fetus, Doppler ultrasonography was performed on all subjects in the beginning and then once a week until the end of Ramadan for the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), and umbilical artery systole/diastole (S/D) ratio. Maternal serum cortisol, triglyceride, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low density lipoprotein (VLDL), and LDL/HDL ratio were also evaluated before and after Ramadan. RESULTS: No significant difference was found between the two groups for the fetal age, maternal weight gain (kilogram), estimated fetal weight gain (EFWG), fetal BPP, AFI, and umbilical artery S/D ratio. In the fasting group, the maternal serum cortisol levels on day 20 were significantly higher than the initial levels obtained 1 week prior to Ramadan (p < 0.05). Although no significant increases were observed in total cholesterol and triglyceride levels in the fasting group, these increases were significantly higher than those in the control group (p < 0.05). LDL and VLDL levels showed a non-significant decrease at the end of the Ramadan. HDL levels showed a slight increase, but LDL/HDL ratios were significantly decreased in fasting group (p < 0.05). CONCLUSION: The results of this study showed that maternal serum cortisol level was elevated while LDL/HDL ratio were decreased in healthy women with uncomplicated pregnancies of 20 weeks or more, who were fasting during Ramadan. No untoward effect of Ramadan was observed on intrauterine fetal development.

Effect of fasting during Ramadan on fetal development and maternal health.

AIM: The aim of the present study was to determine whether fasting during Ramadan causes ketonemia and/or ketonuria and their effects on fetal intrauterine development. METHODS: Thirty-six consecutive healthy women with uncomplicated pregnancies of >or=20 weeks of gestation who were fasting during Ramadan were included in the study group (group 1). The control group (group 2) consisted of 29 healthy pregnant women who were not fasting. Doppler ultrasonography was performed in all subjects in the beginning and at the end of Ramadan to evaluate the changes in the following measurements: fetal biparietal diameter; fetal femur length; and estimated fetal body weight. Fetal biophysical profile, amniotic fluid index, and umbilical artery systole/diastole ratio were measured in the beginning and at the end of Ramadan. Effects of fasting on the mother were evaluated by measuring serum concentrations of 3ss hydroxybutyrate and glucose, and urinary concentration of ketone. Subjects with any of the followings were excluded: diabetes; thyroid dysfunction; Cushing's syndrome; adrenal disease; pre-eclampsia; and multiple pregnancy. RESULTS: The mean duration of fasting in the study group was 18 +/- 2.1 days. The mean maternal glucose level was significantly lower in the study group than in the control group (P = 0.003). No statistically significant differences were found between the two groups in the comparisons of other parameters. CONCLUSION: We concluded that fasting during Ramadan does not lead to maternal ketonemia or ketonuria in pregnant women. In addition, fasting during Ramadan has no significant adverse effect on intrauterine fetal development or the fetus's health.

High prevalence of diffuse parenchymal lung diseases among Turkish tinners.

The objective is to investigate the prevalence of parenchymal lung diseases among tinners. Twenty-four tinners who signed an informed consent form in the Gaziantep area were the subjects of this study. Demographics, spirometric test results, and high resolution computed tomography (HRCT) scans were obtained for all the tinners. Out of 24 tinners, eleven tinners (46%) had HRCTs consistent with DPLD. Of these 11 subjects, HRCT findings were consistent with respiratory bronchiolitis interstitial lung disease in nine, usual interstitial pneumonia pattern in one, and non-specific interstitial pneumonia in one. HRCT patterns consistent with DPLDs are significantly prevalent among Turkish tinners. This is the first field study reporting this occupational lung hazard in tinners. Future research is needed to uncover the underlying mechanisms.

"Unertan syndrome" in two Turkish families in relation to devolution and emergence of Homo erectus: neurological examination, MRI, and PET scans.

"Unertan syndrome" consists of two main symptoms: quadrupedal gait and primitive cognitive abilities including language and conscious experience. To assess the central mechanisms involved in this syndrome, the authors performed MRI and PET scans on affected and unaffected individuals from both families. All affected individuals were also subjected to neurological examination. To assess the integrity of the peripheral and central vestibular system, Barany's caloric test was applied to the affected individuals. Brain MRI and PET scans were performed on normal subjects (n = 7) and patients (n = 7). Right- and left-cerebral and cerebellar areas, including the vermial and callosal areas, were measured on the MRI scans using a computer cursor. Quadrupedal gait, mental retardation, dysartric speech, nystagmus, severe truncal ataxia, hyperreflexia, astasia, and abasia were observed in the affected individuals from both families. Cerebellum and vermis were atrophic in the MRI and PET scans of the first family. In contrast, the brain MRI seemed to be normal in the MRI and PET scans of affected individuals from the second family. The caloric test revealed central vestibular damage in patients from the first family and peripheral vestibular damage in patients from the second family. The results suggest that "Unertan syndrome," discovered in two unrelated families, may be caused by peripheral or central vestibular damage resulting from different genetic defects. Cerebellar hypoplasia may not be a prerequisite for the emergence of this syndrome. Primitive mental abilities may be explained by damage within the vestibulo-cerebellar system, whereas the quadrupedal gait may be due to a genetic defect within the higher brain centers that suppress the atavistic brain networks controlling quadrupedal gait and helped in the emergence of the habitual bipedal gait during human evolution. This retarded development of human locomotion - devolution - may illuminate the brain mechanisms responsible for the transition from quadrupedality to bipedality in human evolution.

Unertan syndrome: a case series demonstrating human devolution.

A large family with six individuals exhibiting the Unertan syndrome (UTS) was identified residing in southern Turkey. All of the individuals had mental impairments and walked on all four extremities. The practice of intra-familial marriages suggested that the UTS may be an autosomal recessive disorder, similar to previously described cases. The inferior portions of the cerebellum and vermis were absent as evidenced by MRI and CT scans. The height and head circumference of those affected were within normal ranges. Barany's test suggested normal vestibular system function. The subjects could not name objects or their close relatives. The males (n = 4) could understand simple questions and commands, but answered questions with only one or two sounds. The females (n = 2) were superior to the males with respect to language skills and walking, suggesting an association between walking and speaking abilities. One male exhibited three walking patterns at the same time: quadripedal, tiptoe, and scissor walking. Another male used two walking styles: quadripedal and toe-walking. It is emphasized that there are important differences between the UTS and the disequilibrium syndrome. It is suggested that the inability to walk upright in those affected with the UTS may be best explained by a disturbance in lateral-balance mechanisms, without being related to the cerebello-vestibular system. An interruption of locomotor development during the transition from quadripedality to bipedality may result in habitual walking on all four extremities and is normal in some children. Because quadripedal gait is an ancestral trait, individuals with the UTS, exhibiting a manifestation of reverse evolution in humans, may be considered an experiment of nature, useful in understanding the mechanisms underlying the transition from quadripedality to bipedality during human evolution. The proposed mutant gene or gene pool playing a role in human quadrupedality may also be responsible for human bipedality at the same time. Herein there is no intent to insult or injure; rather, this report is an endeavor to better understand human beings. Supplementary materials are available for this article. Go to the publisher's online edition of International Journal of Neuroscience for the following free supplemental resource(s): video clips.

Color Doppler twinkling artifact in intrauterine fetal demise.

PURPOSE: To determine whether twinkling artifacts on color and power Doppler sonography could be used as a new sonographic sign of intrauterine fetal demise (IUFD). METHODS: In this prospective study, 24 consecutive pregnant women with IUFD were included after fetal sonographic examinations. Sonographic examination included gray-scale, color, power, and spectral Doppler imaging. The sonograms were then analyzed for the presence, appearance, and intensity of the twinkling artifacts. RESULTS: Twinkling artifacts on color Doppler were observed in all of the 24 IUFD as a rapidly changing color Doppler signal complex associated persistently with different parts of the fetal body. The artifacts were localized especially in the neck, back, and iliac regions. Artifact intensity correlated with the time elapsed since death. CONCLUSION: Twinkling artifact was noted in all dead fetuses on color, power, and spectral Doppler examinations. Thus, the observation of these artifacts may be considered as a new sonographic sign of fetal demise, which may reflect the time elapsed since death.

Noninvasive assessment of benign lesions of vocal folds by means of ultrasonography.

OBJECTIVES: Although ultrasonography (US) has been widely used in various parts of the body, its application in laryngeal examination has been limited. Our objective was to evaluate the significance of US examination in benign lesions of the vocal folds. METHODS: Ultrasonographic examination of the vocal folds was performed in 14 patients in whom benign lesions of the vocal folds had been diagnosed by videolaryngoscopy and microlaryngoscopy. Microlaryngoscopic surgery was performed after US examination. Each lesion was analyzed for the following US features: shape, size, and echotexture (echogenicity and homogeneity). RESULTS: In total, 16 lesions were diagnosed in 14 patients by means of videolaryngoscopy and microlaryngoscopy. Ultrasonographic examination was capable of diagnosing 14 of the 16 lesions (87.25%). Ultrasonography mainly helped in the diagnosis of sessile polyps, nodules, and leukoplakia that were larger than 2 mm. The lesions were linear hyperechoic, heterogeneous hyperechoic, hypoechoic, and isoechoic if they were leukoplakia, nodules, hemorrhagic polyps, and other polypoid lesions, respectively. The results are better if the diagnosis follows the corresponding US echotexture pattern rather than videolaryngoscopy and microlaryngoscopy. CONCLUSIONS: Laryngeal US examination appears to be a useful diagnostic tool for supplementing microlaryngoscopy in the assessment of benign lesions of vocal folds. In contrast to these currently used imaging techniques, anesthesia is not necessary in laryngeal US examination. In addition, US is noninvasive, painless, and much less expensive than the other techniques.

Second-trimester diagnosis of osteogenesis imperfecta associated with schizencephaly by sonography.

Osteogenesis imperfecta is a congenital connective tissue disorder characterized with multiple bone fractures, short limbs, membranous calvarium with wormian bones, and sometimes blue sclerae. Osteogenesis imperfecta is rarely accompanied by other major malformations. Although associations with microcephaly, congenital heart defects or anencephaly have been reported previously, association with schizencephaly was not found on literature review. We report a case of osteogenesis imperfecta associated with schizencephaly diagnosed at 21 weeks of gestation using 2-dimensional ultrasound. The present case shows that prenatal ultrasonographic examination is a very important tool to detect such intrauterine abnormalities in which, management of pregnancy would be changed significantly compared to normal pregnancies.

Prenatal sonographic diagnosis of an extensive fetal axillary hemangiolymphangioma.

Hemangiolymphangioma (HL) is an extremely rare malformation of both the lymphatic and blood vessels. We present a case of fetal axillary HL that was diagnosed sonographically at 36 weeks' gestation. Sonographic examination revealed a large, multilocular, cystic mass consistent with lymphangioma. At birth, a giant hemangioma was noticed involving the right hemitruncus. Based on clinical and sonographic findings, a diagnosis of HL was made. Surgical treatment was considered but was refused by the parents. The neonate died at 14 days of age, possibly due to an intralesional hemorrhage.

Cephalopagus conjoined twins presented with encephalocele: diagnostic role of ultrafast MR imaging.

Conjoined twinning is a rare abnormality and cephalopagus is a very rare form of conjoined twins. We report a case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasonography and ultrafast magnetic resonance (MR) imaging at 24 weeks of the gestation. Ultrafast MR imaging can provide image quality superior to two dimensional ultrasonography and should be considered an adjunct to ultrasound for antenatal characterization of some anomalies. To the best of our knowledge, this is the first case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasound and ultrafast MR imaging.

Primary tuberculosis of the breast.

Primary tuberculosis of the breast is a rare disease. Mammographic, sonographic, and computed tomographic features of a case of primary tuberculosis in the breast are presented. Differential diagnosis with other benign and malign diseases of the breast can be difficult with imaging methods. In endemic areas, tuberculosis should be considered in the differential diagnosis of breast tumors.

Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms.

In this study, we aimed to assess anatomical relationship between the anterior inferior cerebellar artery (AICA) and cochleovestibular nerve (CNV) in patients with non-specific cochleovestibular symptoms using magnetic resonance imaging (MRI). One-hundred and forty patients with non-specific neuro-otologic symptoms were assessed using cranial and temporal MRI. Classification was performed according to four different types of anatomical relationship observed between the AICA and CVN. In type 1 (point compression), the AICA compresses only a limited portion of the CVN. In type 2 (longitudinal compression), the AICA approaches the CVN as both traverse parallel to each other. In type 3 (loop compression), the vascular loop of the AICA encircles the CVN. In type 4 (indentation), the AICA compresses the CVN so as to make an indentation in the nerve. The anatomical relationship between the CVN and AICA was encountered in 19 out of 140 (13.6%) patients (20 ears). The VCC was unilateral in 18 patients (94.7%) and bilateral in one patient (5.3%). There was no other vascular structure causing VCC to the CVN except for vertebral artery that was seen in 2 out of 140 patients (1.4%). These were unilateral cases. There were tinnitus, vertigo or dizziness, hearing loss, and both hearing loss and vertigo in 5 (25%), 13 (65%), 1 (5%) and 1 (5%) ears of 20 patients, respectively. There was no relationship between the cochleovestibular symptoms and type of compression (p>0.05). Neurovascular relationship between the CVN and AICA can be imaged properly using MR and MR based classification may help reporting this relationship in a standard way. Although, MR images can show the anatomical relationship accurately, diagnosis of vascular conflict should not be based on imaging findings alone.

Effects of three different sterilization methods on utero-ovarian Doppler blood flow and serum levels of ovarian hormones.

OBJECTIVE: The aim of the study was to assess pre-operative and post-operative serum levels of ovarian hormones and changes in utero-ovarian arterial blood flow by Doppler ultrasonography in women in whom one of three different sterilization methods was applied. STUDY DESIGN: The Pomeroy method of tubal ligation, fimbriectomy, or laparoscopic bipolar coagulation were applied in 42 patients. Serum levels of sex hormones were checked, and utero-ovarian arterial Doppler measurements were performed pre-operatively and post-operatively. The presence or absence of dysmenorrhea was noted before and after the operations. RESULTS: We detected a significant increase in the average uterine arterial resistivity index (RI) and both ovarian arterial pulsatility index (PI) values in the Pomeroy method group (p<0.05). There was a significant increase in dysmenorrhea complaints in the total number of patients (p<0.05), particularly in the fimbriectomy group. CONCLUSION: The significant increase in uterine arterial Doppler measurements with the Pomeroy method may be due to the removal of a larger tubal segment. Even though the increase is not statistically significant, fimbriectomy should not be applied in young women, because it may increase dysmenorrhea and the procedure is not reversible.

Color Doppler sonographic findings in penile fracture.

We performed color Doppler sonographic examination on 4 patients, 3 of whom had preliminary diagnoses of penile fracture and 1 of whom had undergone an operation due to penile fracture a year previously. Color Doppler sonography helped evaluate the relationships between the hematoma and the vascular structures and aided in differential diagnosis of the vascular injuries that may accompany tunical rupture (or have similar clinical presentations) and Mondor's disease; thus, this method has a crucial role in choosing the treatment approach. Color Doppler sonography may also assist in the follow-up of patients after surgical or conservative treatment.

Primary pure ovarian choriocarcinoma mimicking ectopic pregnancy: a report of fulminant progression.

Nongestational choriocarcinoma of the ovary is a germ cell tumor with a worse prognosis than gestational choriocarcinoma. In this report we present a nongestational choriocarcinoma that was referred to our hospital as an ectopic pregnancy. The clinical features, management, and outcome are discussed.