The role of CT angiography and endovascular treatment in acute-massive head and neck bleeding.

PURPOSE: To report the results of the endovascular treatment of acute-massive head and neck bleeding in a single center and underline the value of computerized tomography-angiography and endovascular treatment of this desperate patient group. METHODS: Forty-eight patients who suffered from acute-massive head and neck bleeding and in whom conservative treatment options had failed were included in the study. To localize the site of the bleeding, computerized tomography-angiography was obtained above the supra-aortic level. Depending on the type and site of bleeding, an urgent angiographic evaluation and appropriate endovascular treatment procedure were performed in the same session immediately. Complete control of all active bleeding was determined as "technical success" at the end of the procedure. RESULTS: The majority of the endovascular treatment indications were tumoral mass bleedings in this study. Eight patients, all of which had head and neck tumors as the cause of the bleeding underwent repeated interventional procedures due to acute re-bleeding. All patients left the angiography unit with technical success and dramatic clinical improvement. Two patients had procedure-related severe complications, such as contrast-induced nephropathy and acute cerebrovascular accident. One patient died due to massive re-bleeding during the follow-up period. CONCLUSION: Computerized tomography-angiography is a successful imaging method to reveal the location and cause of bleeding. Endovascular treatment of acute-massive head and neck bleeding is an effective and life-saver treatment option that can be used successfully with relatively low-risk potential.

Dermoid cyst with cerebellar meningoencephalocele at different locations accompanied by posterior fossa abnormalities: case report

ABSTRACT CONTEXT: Dermoid cysts are well-defined cysts containing sebaceous glands and dermal structures. In the literature, dermoid cysts and associated closure defects have been described in the same locations. CASE REPORT: In this case, a dermoid cyst was found at the base of the mouth with a coexisting closure defect in the occipital calvarium. Additional abnormalities were also observed, including posterior myeloschisis, right cerebellar dysgenesis, vermian hypogenesis and posterior fusion of the second and third vertebrae. The finding of a dermoid cyst located at the base of the mouth is discussed here, with additional imaging findings. CONCLUSION: Dermoid cysts in the head and neck region may be accompanied by posterior fossa abnormalities.

Dermoid cyst with cerebellar meningoencephalocele at different locations accompanied by posterior fossa abnormalities: case report.

CONTEXT: Dermoid cysts are well-defined cysts containing sebaceous glands and dermal structures. In the literature, dermoid cysts and associated closure defects have been described in the same locations. CASE REPORT: In this case, a dermoid cyst was found at the base of the mouth with a coexisting closure defect in the occipital calvarium. Additional abnormalities were also observed, including posterior myeloschisis, right cerebellar dysgenesis, vermian hypogenesis and posterior fusion of the second and third vertebrae. The finding of a dermoid cyst located at the base of the mouth is discussed here, with additional imaging findings. CONCLUSION: Dermoid cysts in the head and neck region may be accompanied by posterior fossa abnormalities.

Evaluation of anterior intermeniscal ligament in discoid lateral meniscus cases and presenting the accompanying meniscal pathologies with MRI.

BACKGROUND: Although several studies were conducted to put forth the biomechanical function of anterior intermeniscal ligament (AIML) on the stability of meniscal structures, there are few data on the etiology of the early degeneration of discoid type compared to the normal shaped ones. PURPOSE: To determine the AIML subtypes and accompanying meniscal pathologies in discoid lateral menisci (DLM) on knee MRI exams. MATERIAL AND METHODS: Knee MRI exams of 171 individuals with DLM were reviewed. DLMs and AIMLs were typed according to Watanabe's classification and Nelson-Laprade classification, respectively. Medial and lateral menisci were evaluated for tear and menisco-capsular pathology. Pearson's correlation test was used for statistical analysis. RESULTS: DLM was type I in 83 (48.5%) individuals and type II in 88 (51.5%) individuals. AIML was absent in 90 (52.6%) participants; type I AIML was seen in 38 out 81 (22.2%), type II in 31 out of 81(18.1%), and type III in 12 out of 81 (7%). Meniscal pathology was observed in 56 (32.7%) individuals as follows: menisco-capsular strain/separation in 25 (14.6%); medial meniscal tear in 22 (12.8%); and lateral meniscal tear in nine (5.2%); Of these 56 cases, 26 (46%) had no AIML, 15 cases (27%) had type I, nine cases (16%) had type II, and six cases (11%) had type III AIML. CONCLUSION: No statistically significant correlation was found between the type of DLM and type of AIML ( P = 0.855), between the type of DLM and meniscal pathology ( P = 0.791), or between the type of AIML and meniscal pathology ( P = 0.282).

The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia.

Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Patients were assessed with standard and dynamic coccyx radiographs and classified according to coccygeal mobility. Pain scores were assessed with a numerical rating scale (NRS) before and after the intervention (at 1 hour and 4, 12 and 24 weeks). A 50% or more reduction in the NRS score was accepted as significant pain relief. Results Of the 37 patients included in the study, 14 had normal coccyx (Group I) and 23 had immobile coccyx (Group II) based on the radiological evaluation. The NRS scores were significantly reduced in both groups on each follow-up visit but there was no significant difference between the two groups in terms of pre- and post-intervention NRS scores. Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes.

MRI evaluation of ligaments and tendons of foot arch in talar dome osteochondral lesions.

Background There are no publications in literature describing an association between disorders of the ligaments and tendons supporting the foot arch and osteochondral lesions of the talus (OCLT). We believe there may be a correlation between the damage of these structures. Purpose To investigate the pathologies of main ligaments and tendons that support the foot arch in sprained ankles, by reviewing magnetic resonance imaging (MRI) studies and comparing the results in two groups of patients, with and without OCLT. Material and Methods MR images from 316 patients examined in the orthopedic clinic for ankle sprain were evaluated for pathologic findings of the plantar fascia, short and long plantar ligaments, spring ligament, sinus tarsi, and ankle tendons supporting the foot arch. Findings were compared between two groups of patients: 158 patients with OCLT and 158 patients without OCLT. Results Plantar fascia, short plantar ligament, and spring ligament abnormalities were seen in 50 (31.6%), 28 (17.7%), and 60 (38%) patients with OCLT, and in nine (5.6%), three (1.9%), and 18 (11.4%) patients without OCLT, respectively ( P < 0.05). Sinus tarsi and tendon abnormalities were seen in 11 (6.7%) and nine (5.7%) patients with OCLT, and in eight (5%) and eight (5%) patients without OCLT, respectively ( P > 0.05). Two or more associated abnormalities were present in 50 (31.6%) patients with OCLT and in 11 (6.7%) without OCLT ( P < 0.05). Conclusion Plantar fascia, short plantar ligament, and spring ligament abnormalities were commonly seen in patients with OCLT on MRI, while sinus tarsi and tendon abnormalities were not. Concomitant pathologies have an increased incidence in patients with OCLT.

Unusual Presentation of Hydatid Cyst in Breast with Magnetic Resonance Imaging Findings.

We report a case of 59-year-old woman with a painful left breast mass, compatible with types II-III hydatid cyst. Lesion was evaluated with mammography, ultrasound, computed tomography, and magnetic resonance imaging modalities. Magnetic resonance imaging had important diagnostic role with demonstrating characteristic features of the lesion and had capability of showing complications. Surgery also confirmed the diagnosis of a hydatid cyst.

Endoscopic Management of Colonic Perforation due to Ingestion of a Wooden Toothpick.

BACKGROUND Toothpick ingestion is implicated in bowel injuries that may cause violent complications, mimicking diseases causing acute abdomen. CASE REPORT A 18-year-old man was admitted with a 3-day history of a swallowed wooden toothpick. The patient had tenderness in the left flank area. Computed tomography indicated toothpick impaction at the splenic flexura of the colon. It was successfully removed with colonoscopy. After the procedure, abdominal radiography showed free air as a sign of perforation. Along with conservative management, the patient was discharged without surgery. CONCLUSIONS There is need for greater awareness of the hazardous of an ingested toothpick. Endoscopic approach should be considered in the first-line management of toothpick perforations.