Raftlin and 8-iso-prostaglandin F2α levels and gene network analysis in patients with Modic changes.

PURPOSE: Oxidative stress in the vertebral endplates of patients with low back pain and Modic changes (MCs) (types I, II, and III) endplate changes on magnetic resonance imaging. 8-iso-prostaglandin F2α (8-iso-PGF2α) has been proposed as new indicator of oxidative stress. Raftlin, as an inflammatory biomarker, has been previously reported in inflammatory diseases. Oxidative stress plays an important role in various human diseases. This study was aimed to assess Raftlin and 8-iso-PGF2α levels in patients with MCs. METHODS: Patients with MCI, II, and III (n = 45) and age- and sex matched controls subjects (n = 45) were enrolled in this study. 8-iso-PGF2α and Raftlin levels in the serum samples of both groups were measured with enzyme-linked immunosorbent assay. RESULTS: In our study results, raftlin levels changed in parallel with prostaglandin levels (p < 0.05). Raftlin levels changed in parallel with prostaglandin levels (p < 0.05). The levels of 8-iso-PGF2α and Raftlin levels showed increase in patients with MCs and the control group (p < 0.05). In addition, a significant positive correlation was found between MC-I, MC-II, MC-III and Raftlin (r = 0.756, 0.733, 0.701 p < 0.001, respectively). A significant positive correlation was found between ISO (Respectively; r = 0.782, 0.712, 0.716 p < 0.001). In our evaluation between Raftlin and Iso, a significant positive relationship was determined. (r = 0.731, p < 0.001). CONCLUSION: Our findings indicated that oxidative stress in patients with MC-I may be aggravated and it may cause an inflammation formation of the lesion areas in these patients. Also, the increased 8-iso-PGF2α and Raftlin levels in patients with MC-II and MC-III may be an adaptive response to against oxidative stress.

Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis.

OBJECTIVE: It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients. SUBJECTS AND METHODS: A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. RESULTS: Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000). CONCLUSION: There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.

Assessment of enthesopathy in patients with fibromyalgia by using new sonographic enthesitis index.

OBJECTIVE: The aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). METHODS: This study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Student's t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P < 0.05 were considered significant. RESULTS: Total enthesitis score was 7.39 ± 4.99 (mean ± SD) among FM patients and 3.7 ± 3.22 among healthy controls (P < 0.001). The receiver operating characteristic curve established an ultrasound score of > 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. CONCLUSIONS: Misdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

Anaphylaxis due to spontaneous rupture of primary isolated splenic hydatid cyst.

Echinococcosis is a helminthic zoonosis mainly caused by Echinococcus granulosus and commonly encountered in endemic areas. The liver and lung are the most frequently involved organs. A primary isolated hydatid cyst of spleen is an extremely rare disease even in endemic areas. Anaphylactic reaction is a known complication of cystic hydatid disease, a parasitic infestation caused by the larval/cyst stage of E. granulosus that usually occurs after trauma or during interventions. To the best of our knowledge, anaphylaxis with spontaneous rupture of primary isolated splenic hydatidoses had not been reported previously. The main purpose of this report is to highlight life-threatening complications such as anaphylactic shock that should be considered due to primary isolated splenic cyst hydatid rupture in especially endemic regions.

Avaliação de entesopatia em pacientes com fibromialgia por meio do novo índice ultrassonográfico de entesite / Assessment of enthesopathy in patients with fibromyalgia by using new sonographic enthesitis index

OBJETIVO: Determinar a frequência de entesopatia na fibromialgia (FM) utilizando um método de ultrassonografia (US) recém-desenvolvido, o escore Madrid Sonography Enthesitis Index (MASEI). MÉTODOS: Este estudo foi realizado em 38 pacientes com FM consecutivos e 48 controles saudáveis pareados para idade e sexo. Seis sítios de ênteses (tuberosidade do olécrano, polos superior e inferior da patela, tuberosidade tibial, polos superior e inferior do calcâneo) nos dois membros inferiores foram avaliados. Todos os achados da US foram identificados de acordo com o escore MASEI. Os escores de pacientes e controles foram comparados usando-se o teste t de Student e o teste U de Mann-Whitney. A validade foi analisada pela curva receiver operating characteristic (ROC). Valores de P < 0,05 foram considerados significativos. RESULTADOS: O escore total de entesite foi 7,39 ± 4,99 (média ± DP) para os pacientes com FM e 3,7 ± 3,22 para os controles saudáveis (P < 0,001). A curva ROC estabeleceu um escore de US > 3,5 no grupo de FM como o melhor ponto de corte para diferenciar casos de controles. Não houve correlação estatisticamente significativa entre o escore MASEI e a duração da FM, e a localização dos pontos dolorosos. CONCLUSÕES: Erros no diagnóstico de FM são prejudiciais aos pacientes e à comunidade, e a presença de entesopatia entre pacientes com FM é crescente. Sua detecção por meio do escore MASEI pode ser útil para discriminar pacientes com FM, cujos sintomas e sinais são mal definidos, para evitar equívoco de tratamento.

OBJECTIVE: The aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). METHODS: This study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Student's t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P < 0.05 were considered significant. RESULTS: Total enthesitis score was 7.39 ± 4.99 (mean ± SD) among FM patients and 3.7 ± 3.22 among healthy controls (P < 0.001). The receiver operating characteristic curve established an ultrasound score of > 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. CONCLUSIONS: Misdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

Increased enthesopathy in patients with familial Mediterranean fever: evaluation with a new sonographic enthesitis index.

OBJECTIVES: The aim of this study was to determine the frequency of enthesopathy in familial Mediterranean fever by using a newly developed sonographic method, the Madrid Sonographic Enthesitis Index (MASEI). METHODS: The study included 50 consecutive patients with familial Mediterranean fever and 57 healthy sex- and age-matched control participants. Six entheseal sites (olecranon tuberosity, superior and inferior poles of the patella, tibial tuberosity, and superior and inferior poles of the calcaneus) on both lower limbs were evaluated. All sonographic findings were identified according to MASEI. Validity was analyzed by receiver operating characteristic curves. P < .05 was considered significant. RESULTS: Mean total enthesitis scores ± SD were 7.54 ± 4.99 for patients and 3.63 ± 3.03 for controls (P < .001). No statistically significant correlation was found between the MASEI score and familial Mediterranean fever duration or colchicine treatment duration. There was no difference between the MASEI score and the presence or absence of arthritic involvement among the patients. The area under the receiver operating characteristic curve was 0.74 (95% confidence interval, 0.649-0.839). When analyzed by sex, men with familial Mediterranean fever had significantly higher MASEI scores than women (P < .05). CONCLUSIONS: This study showed significant enthesopathy in patients with familial Mediterranean fever. The findings support the hypothesis that familial Mediterranean fever and spondyloarthropathy may have common inflammatory mechanisms and suggest that the MASEI scoring system can be incorporated into clinical protocols for studying patients with familial Mediterranean fever in daily practice.

Frequency of peripheral arterial disease and venous insufficiency in toenail onychomycosis.

Onychomycosis in toenails is a common fungal infection and vascular abnormalities of lower extremities have been thought as one of the predisposing conditions. The aim of this study was to evaluate predisposition effect of venous insufficiency and peripheral arterial disease on toenail onychomycosis. Thirty-three patients with bilateral onychomycosis in toenails and 37 control subjects, who had healthy nails, were enrolled in the study. Veins and arteries of lower extremities were examined with Doppler ultrasound in terms of venous insufficiency or peripheral arterial disease. Patients with onychomycosis presented more frequent venous insufficiency than the control group (42.4% and 10.8%, respectively; P = 0.003). Although all patients had bilateral onychomycosis, reflux was bilateral in six out of 14 patients with onychomycosis (42.8%). No significant difference in frequency of peripheral arterial disease was found in patients, compared to healthy controls. Our study demonstrated a significant relationship between onychomycosis and venous insufficiency, but not with peripheral arterial disease. Also, we point out discordance with bilateral onychomycosis and unilateral venous insufficiency.

Interobserver variability of ultrasound elastography in transplant kidneys: correlations with clinical-Doppler parameters.

Real-time sonoelastography (RSE) is a relatively new imaging technique that visualizes relative difference in tissue hardness by evaluating changes in local strain in response to external stress. Our aim was to evaluate the ability of investigators to use sonoelastography to detect differences in renal cortical stiffness and assess the relationship between stiffness and clinical-Doppler parameters. In 42 adult renal transplant recipients, sonoelastography of kidney was performed to calculate the strain ratio (SR) of the central echo complex to the renal parenchyma. Resistive index (RI) and pulsatility index (PI) were also measured. Estimated glomerular filtration rate (eGFR) was calculated. Parenchymal stiffness showed significant positive correlation with RI and PI (r: 0.41 p = 0.007 and r: 0.48 p = 0.001, respectively). Parenchymal stiffness and eGFR did not have a significant correlation (p = 0.42). Interobserver agreement, expressed as intraclass correlation coeffiicient was 0.47 (95% CI: 0.05-0.70). Parenchymal stiffness (SR) showed significant positive correlation with RI and PI but sonoelastography has also wide range intra- and low interobserver agreement in renal transplants. Further studies are warranted in larger patient groups to determine the reliability of sonoelastography in renal transplants.

The effects of sonographic and demographic features and needle size on obtaining adequate cytological material in sonography-guided fine-needle aspiration biopsy of thyroid nodules.

The aim of this study is to investigate the effects of the sonographic characteristics of the nodule, demographic features of patient, and nodule size and needle size used for sampling, on obtaining adequate cytological material (CM) in thyroid fine-needle aspiration biopsy (FNAB). We performed 270 FNAB between September 2010 and June 2012. Size, echogenicity, and localization of all nodules were evaluated by ultrasonography (US) before the biopsy. Nodules were grouped as <1, 1-3, and >3 cm according to their size and as hypoechoic, isoechoic, hyperechoic, or heterogeneous according to their US characteristics. 20-, 22-, and 24-G needles were used for the biopsies. Different sonographic characteristics of the nodules did not affect the needle selection. All specimens were classified as adequate or inadequate CM by a cytopathologist. A total of 270 nodules were biopsied, 184 (68.1 %) specimens were considered as adequate CM and 86 (31.9 %) specimens were considered as inadequate CM. Patient age and the presence of heterogeneous echogenicity were found to have prognostic significance in univariate analysis (p < 0.05). In a multivariate logistic regression model with forward stepwise method, advanced age (p = 0.001, OR = 1.042, 95CI 1.018-1.068) and heterogeneous echogenicity (p = 0.017, OR = 1.955, 95CI 1.129-3.385) remained associated with an increased risk of inadequate CM obtainment after adjustment for other potential confounders (nodule size >3 cm and needle size 20-G usage) and variables found to be statistically significant in univariate analysis. Non-diagnostic FNAB remains a significant problem in the evaluation of thyroid nodules and can be as high as 30 %. Inadequate CM rates for elderly patients and heterogeneous nodules were significantly higher than that for other factors. The nodule size and needle size used for sampling did not affect the adequacy of FNAB.

Spinal dural arteriovenous malformation presented with intracranial hypertension in a young patient.

Spinal dural arteriovenous malformations (AVM), the most common type of spinal cord vascular malformation, can be a challenge to diagnosis and prompt treatment. The disorder is rare, and the presenting clinical symptoms and signs are non-specific and insidious at onset. Spinal dural AVMs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. It may rarely present with symptoms of intracranial hypertension including headache and visual disorders. In this report, we present the radiological findings of a 19-year-old male patient with spinal dural AVM presenting with raised intracranial pressure symptoms including papilloedema and headache, and discuss with recent literature.

Sonographic evaluation of subclinical entheseal involvement in patients with Behçet disease.

OBJECTIVE: The aim of the current study was to determine the prevalence of subclinical entheseal involvement in patients with Behçet disease via ultrasound using a newly developed method, the Madrid sonography enthesitis index. SUBJECTS AND METHODS: The study was conducted with 36 patients with Behçet disease and 46 healthy sex- and age-matched control subjects. All patients with Behçet disease who had no clinical evidence of arthritis or enthesitis underwent an ultrasound examination. All sonographic findings were identified according to the Madrid sonography enthesitis index. Madrid sonography enthesitis index values of patients and control subjects were compared by Student t test and Mann-Whitney U test. Validity was analyzed by receiver operating characteristic curve. RESULTS: Total enthesitis score was 12.16 ± 6.16 among patients with Behçet disease and 2.06 ± 2.18 among healthy control subjects (p < 0.001). The receiver operating characteristic curve established an ultrasound score greater than 4.5 in the Behçet disease group as the best cut-off point differentiating case subjects from control subjects. This cutoff was exceeded by 88.8% of the patients with Behçet disease. When the Madrid sonography enthesitis index score in each affected enthesis was evaluated, patients with Behçet disease had significantly higher scores than did control subjects when all entheseal sites were compared (all p values < 0.05). CONCLUSION: This is the first study to our knowledge to show significant subclinical enthesopathy of the triceps tendon enthesis in patients with Behçet disease who had no arthritic involvement. These data suggest that the Madrid sonography enthesitis index scoring system for sonographic detection of enthesopathy should be incorporated into the clinical protocol for evaluating patients with Behçet disease in routine clinical practice.

Evaluation of degenerative diseases of the lumbar spine with reformatted and 3-dimensional computed tomography images.

OBJECTIVE: To evaluate the identification of degenerative lesions of the lumbar spine with multiplanar reformatted images and 3-dimensional computed tomography (3DCT). METHODS: Fifty-three patients with degenerative spinal disease findings on lumbar CT scanning were reviewed in this retrospective study at the Department of Radiology, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey between January 2006 to January 2009. Two-dimensional multiplanar reformatted and 3DCT images were obtained. First, the axial CT images, and then 2-dimensional multiplanar reformatted images (2DMPR) were evaluated. The findings seen on reformatted CT images that were not visualized, or visualized only in retrospect on axial images were recorded. Finally, the 3D images were evaluated by the same team. The results were again recorded in the same manner. RESULTS: When 53 patients were taken into account, the 2DMPR provided better visualization of lateral neural foraminal stenosis in 62%, bulging of the disc in 32%, degenerative retrolisthesis in 15%, and spondylolysis in 15% as compared to axial images. The 3DCT images clearly revealed the presence of lateral neural foraminal stenosis in 41%, degenerative retrolisthesis in 13%, lateral spondylolisthesis in 15% as compared to axial and 2DMPR. CONCLUSION: The 2DMPR and 3DCT images provide significant anatomic and diagnostic information not readily derived from axial CT. It is useful in detecting degenerative conditions of the spine and associated complications.

Estradiol plus drospirenone therapy increases mammographic breast density in perimenopausal women.

OBJECTIVE: To investigate the effects of 17ß-estradiol 1mg plus drospirenone 2mg (E2/DRSP) treatment on mammographic breast density in perimenopausal women. STUDY DESIGN: In this prospective study, 80 healthy perimenopausal women aged 41-49 years were enrolled and assigned to either E2/DRSP (n=40) or a control group (n=40). Mammograms were performed at baseline and after 12 months of treatment. Mammographic breast density was quantified according to the Wolfe classification. RESULTS: We demonstrated an increase in mammographic breast density in 37% (95% CI (confidence interval): 18.8-55.3%) of women treated with E2/DRSP after 12 months. The percentage of women with increased density was 0% (95% CI: 0.0-0.0%) in the control group. The difference in breast density between the E2/DRSP group and the control group was statistically very significant (p<0.001). CONCLUSIONS: E2/DRSP therapy for 12 months in perimenopausal women significantly increased mammographic breast density in comparison to a control group. Further long-term and large scale prospective studies are needed to evaluate this issue.

Carotid CT angiography: comparison of image quality for left versus right arm injections.

PURPOSE: To evaluate the differences in image quality of carotid computed tomographic angiography (CTA) of patients injected with contrast material in their right arms versus patients injected with contrast material in their left arms. MATERIALS AND METHODS: Patients who had cerebrovascular accidents and subsequently underwent CTA were included in the study. Contrast material was injected into the right arms of 44 patients and into the left arms of 46 patients. Source images of a total of 90 CTAs were retrospectively evaluated for perivenous streak artifacts and contrast material reflux into the veins of the neck and upper thorax. After adjusting for differences in gender, the relationship between the injection site and the intensity of perivenous streak artifacts and venous reflux was determined. RESULTS: Perivenous streak artifacts and venous reflux were demonstrated in patients who underwent either right or left arm injections. However, the intensity of perivenous streak artifacts was stronger in patients who were injected with contrast material in the left arm. Venous reflux into the neck and upper thorax veins was also more severe and more frequent with left arm injections. A decreased retrosternal distance facilitated reversed flow into the veins when the left arm injection was used. CONCLUSION: Perivenous beam hardening streak artifacts and venous reflux could not be prevented with right or left arm injections. However, patients who were injected with contrast material in their right arms showed fewer artifacts, thus allowing for better quality images on CTA.

Interstitial lung disease in coppersmiths in high serum copper levels.

Coppersmith is a worker who uses copper most commonly for the production of kitchen appliances in Turkey. This is an ancient occupation practiced for centuries in Turkey. Our objective was to investigate the prevalence of parenchymal lung diseases among coppersmiths in Kahramanmaras city in Turkey. Thirty coppersmiths were included to the study, and they all signed an informed consent. Demographics, spirometric test results and high-resolution computed tomography (HRCT) scans, and blood samples were obtained. Laboratory analysis of the serum samples showed that serum copper levels of the subjects were 0.93 +/- 0.14 mg/L. Serum copper level in control group was found as 0.70 +/- 0.14 mg/L, and it was significantly different between the two groups (p < 0.05). Of 30 coppersmiths, 17 HRCT findings are abnormal and seen with diffuse parenchymal interstitial lung disease pattern-ten (58.8%) respiratory bronchiolitis interstitial lung disease, five (29.4%) nonspecific interstitial pneumonia, and two (11.8%) usual interstitial pneumonia. The most prevalent HRCT pattern was micronodular pattern in workers. This is the first field study reporting the radiologic findings of coppersmiths and effect of the occupation on lung diseases.

Occipitocervical vertical distraction injuries: anatomical biomechanical, and 3-tesla magnetic resonance imaging investigation.

STUDY DESIGN: Biomechanical load-to-failure findings correlated with anatomic dissection measurements and intact (prefailure) 3-Tesla (3-T) magnetic resonance images (MRI). OBJECTIVE: To better understand why the same distractive force to the head can result in occipitoatlantal dislocation (OAD) in some individuals and atlantoaxial dislocation (AAD) in others. SUMMARY OF BACKGROUND DATA: Distraction injuries to the cranio-vertebral junction have been studied biomechanically but have not been studied relative to ligamentous anatomic variations. We theorized that morphologic variations in the ligaments should influence the injury pattern during axial distraction. METHODS: After obtaining 3-T MRI scans, 10 occiput-C2 specimens were loaded to failure under axial tension. Direct anatomic measurements were also obtained from the distracted and injured specimens. RESULTS: AAD was observed in 7 specimens (mean force +/- standard deviation 1229 +/- 181 N) at a significantly higher magnitude than OAD, which was observed in 3 specimens (823 +/- 127 N; P = 0.009, nonpaired t test). In OAD specimens, the superior cruciate ligament (SCL), which was smaller than the inferior cruciate ligament (ICL), failed. The apical ligament was unidentifiable in these 3 specimens. In 5 of the 7 AAD specimens, the ICL ruptured and was smaller than the SCL. In the remaining 2 specimens, both SCL and ICL ruptured. The apical ligament, which ruptured, was identifiable in all 7 specimens. CONCLUSION: Axial distraction across the cranio-vertebral junction can produce either OAD or AAD. The SCL and ICL dimensions, alar ligament orientations, and apical ligament presence may affect the injury site. Visualization with 3-T MRI allows better understanding of the injury mechanism and location, which is important clinically in selecting single- or multilevel fixation.

Hydatid disease involving some rare locations in the body: a pictorial essay.

Hydatid disease (HD) is an endemic illness in many countries, and it poses an important public health problem that's influenced by peoples' socioeconomic status and migration that spreads this disease. Although rare, it may occur in any organ or tissue. The most common site is the liver (59-75%), followed in frequency by lung (27%), kidney (3%), bone (1-4%) and brain (1-2%). Other sites such as the heart, spleen, pancreas and muscles are very rarely affected. Unusual sites for this disease can cause diagnostic problems. This pictorial essay illustrates various radiological findings of HD in the liver, spleen, kidney, pancreas, peritoneal cavity, omentum, adrenal, ovary, lung, mediastinum and retroperitoneum. Familiarity with the imaging findings of HD may be helpful in making an accurate diagnosis and preventing potential complications.