Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar

BACKGROUND: The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. MATERIAL AND METHODS: The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. RESULTS: Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. CONCLUSIONS: Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar.

BACKGROUND: The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. MATERIAL AND METHODS: The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. RESULTS: Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. CONCLUSIONS: Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling.

A comparative analysis of surface areas and ratio of the cervical spinal cord and the vertebral canal at the same levels via MRI on healthy individuals / Análisis comparativo de las áreas de superficie y proporción de la médula espinal cervical y el canal vertebral en los mismos niveles via resonancia magnética en individuos sanos

The determination of the normal values of the cross-sectional surface areas and ratios of the vertebral canal and the spinal cord on the healthy individuals is of great importance with regards to the fact that it provides convenience for the doctors to make correct pathological diagnosis because of the most suitable treatment. In this study, it has been aimed to determine the respective ratios between the vertebral canal and the spinal cord via measuring their cross-sectional surface areas at the C3­C6 vertebra levels. The study has been implemented on the Magnetic Resonance Images (MRI) of the cervical vertebral column from healthy individuals at the Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University. The study has been applied to 67 (50 female-17 male) individuals whose ages varied between 14 and 59 and these individuals have been divided into two groups as below and over 40 years of age. During the cervical MRI examination, axial and sagittal images have been evaluated and measurements have been made on the non-pathological axial images. The vertebral canal and the spinal cord surface areas have been calculated in square millimeters at the C3­C6 levels. Also, we calculated the ratio between the spinal cord surface area and the vertebral canal surface area. The obtained data has been transferred on the computer and statistical analysis has been implemented via SPSS package program (for Windows, 15.0). The summary of the data has been stated as Mean±SD. It has also been compared with regard to sex and age groups (below and over 40 years of age) using the Student t-test. The relationship between parameters has been evaluated by means of Pearson correlation test. No significant discrepancy (P>0.05) has been determined between the male and the female subjects in terms of the vertebral canal and spinal cord surface area values. On the other hand, at the C4, C5 and C6 levels, a significant discrepancy (P<0.05) has been observed between male and female subjects in terms of the ratio of spinal cord surface to the vertebral canal surface, stating that the male have it larger than the female. A positive correlation (P<0.01) between the surface area and ratio data of both sexes has been determined. We believe that the results of this study will be useful for the fields of neurology, neurosurgery and physical therapy and rehabilitation, particularly in evaluating spinal atrophy.

La determinación de los valores normales de las áreas de superficie de la sección transversal y las proporciones del canal vertebral de la médula espinal en los individuos sanos es de gran importancia para los médicos, para realizar un diagnóstico patológico correcto y un tratamiento más adecuado. Este estudio se llevó a cabo para determinar las respectivas proporciones entre el canal vertebral y la médula espinal a través de la medición transversal de áreas de superficie, entre los niveles de las vértebras C3­C6. El estudio se realizó através de imágenes de resonancia magnética (IRM) de la columna vertebral cervical de individuos sanos en el Departamento de Radiología, de la Facultad de Medicina de Meram, Universidad de Necmettin Erbakan. En el estudio participaron 67 sujetos (50 mujeres, 17 hombres) entre 14 y 59 años de edad. Los sujetos fueron divididos en dos grupos, menores y mayores de 40 años de edad. Durante el examen de IRM cervical, se evaluaron imágenes axiales y sagitales, estas mediciones se realizaron en las imágenes axiales no patológicas. El canal vertebral y las áreas de superficie de la médula espinal fueron calculados en milímetros cuadrados entre los niveles C3­C6. Además, se calculó el cociente entre el área de superficie de la médula espinal y la superficie del canal vertebral. Los datos obtenidos de superficie del canal vertebral, fueron transferidos al equipo y el análisis estadístico se implementó a través del programa SPSS (para Windows, 15.0). El resumen de los datos fue declarado como Media±DE. También fueron comparados grupos entre ambos sexos y por edad (menores y mayores de 40 años de edad) através de la prueba t de Student. La relación entre los parámetros fue evaluada mediante la prueba de correlación de Pearson. No se observó discrepancia significativa (P>0,05) entre hombres y mujeres en términos del canal vertebral, y los valores de la columna vertebral de la zona de superficie dorsal. Por otro lado, a nivel C4, C5 y C6, se observó una discrepancia significativa (P<0,05) entre hombres y mujeres, en términos de la proporción de la superficie de la médula espinal y la superficie del canal vertebral, indicando que fue mayor en los hombres. Se determinó una correlación positiva (P<0,01) entre el área de superficie y los datos de proporción de ambos sexos. Creemos que los resultados de este estudio serán de utilidad en las áreas de la neurología, neurocirugía, como también en terapia física y rehabilitación, en particular en la evaluación de la atrofia espinal.

Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: A pilot study

OBJECTIVES: The aim of the present study was to investigate the analgesic and anti-inflammatory effects of dexketoprofen trometamol (DT) and paracetamol on deep acute somatic pain and inflammation in patients undergoing impacted third molar surgery. This study was planned to present benefits that we could obtain with low burden of drug. Study DESIGN: Effects of drugs, which were administered preemptively before the procedure, on pain, mouthopening limitation, and swelling were assessed by visual analogue scale (VAS), magnetic resonance imaging (MRI), and mouth-opening measurement. Following surgery, time intervals when the patients first need to receive the drug were measured. RESULTS: The VAS scores of the patients were lower in the side treated with DT than that in the paracetamol treated side. There was no significant difference between the groups in terms of mouth-opening limitation. MRI recordings revealed that swelling was lower in the side treated with paracetamol than DT treated side. CONCLUSIONS: Administration of the drugs before surgery contributed to the postoperative patient comfort. The analgesic activity of 12.5 mg dose of DT was similar to, even better than, the analgesic activity of 500 mg dose of paracetamol; however, DT had insufficient anti-inflammatory efficacy

The morphometric analysis of the important bone structures on skull base in living individuals with multidetector computed tomography / Análisis morfométrico de las estructuras óseas importantes en base de cráneo de sujetos vivos mediante tomografía computarizada multidetector

In this study, it was aimed to determine the reliable morphometric data of the important bone structures on skull base using MDCT and to establish the differences of these data according to sex and lateralization. This study was retrospectively carried out on MDCT images in the Radiology Department of Meram Medical Faculty, Necmettin Erbakan University. We evaluated the images of the 100 (male 50 ­ female 50) adult subjects without cranial trauma, surgery, and any deformity of the bone. The height and anteroposterior diameter of the hypophysial fossa (HFheight, HFanteroposterior), the length of the occipital condylus, anterior and posterior intercondylar distances (OCn, AID, PID); sagittal diameter, transverse diameter and area of the foramen magnum (FMsgt, FMtrn, FMarea) were all measured. The statistical analysis was performed using the SPSS. The summary of the data was expressed as mean ± standard deviation. Student's t test was used to compare the male-female and right-left measurements. The relation betweeen parameters was evaluated by Pearson's correlation test. It was observed that right and left data in all parameters were higher in males than females. Higher values were usually determined on the right side in both sexes. In both sexes, some parameters were highly correlated (P<0.001). We believe that the results of this study may be useful for new surgical approaches and radiological assessment concerning skull base.

El objetivo de este estudio fue determinar datos morfométricos confiables de las estructuras óseas importantes de la base de cráneo mediante tomografía computarizada multidetector (TCMD) y establecer las diferencias de estos datos en función del sexo y lateralización. Se realizó un estudio retrospectivo a partir de imágenes de TCMD obtenidas en el Departamento de Radiología de la Facultad de Medicina Meram, Universidad de Necmettin Erbakan. Se evaluaron imágenes de 100 sujetos adultos (50 hombres y 50 mujeres), que no presentaban trauma craneal, cirugía o deformidad ósea. Se midieron (i) altura y diámetro anteroposterior de la fosa hipofisaria, (ii) longitud del cóndilo occipital y distancias intercondilares anterior y posterior, y (iii) el diámetro sagital, transversal y el área del foramen magno. El resumen de los datos se expresó como Media±DE. La comparación de los datos entre sexos y mediciones izquierda-derecha se realizó mediante la prueba t de Student, mientras que la relación entre los distintos parámetros mediante la prueba de correlación de Pearson. Todos los parámetros medidos, en el lado derecho e izquierdo, fueron mayores en hombres. Los valores más altos se determinaron generalmente en el lado derecho en ambos sexos. Algunos parámetros estuvieron altamente correlacionados en ambos sexos (P<0,001). Creemos que nuestros resultados pueden ser útiles al momento de realizar nuevos abordajes quirúrgicos y en la evaluación radiológica, relativas a la base de cráneo.

Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: A pilot study.

OBJECTIVES: The aim of the present study was to investigate the analgesic and anti-inflammatory effects of dexketoprofen trometamol (DT) and paracetamol on deep acute somatic pain and inflammation in patients undergoing impacted third molar surgery. This study was planned to present benefits that we could obtain with low burden of drug. STUDY DESIGN: Effects of drugs, which were administered preemptively before the procedure, on pain, mouth-opening limitation, and swelling were assessed by visual analogue scale (VAS), magnetic resonance imaging (MRI), and mouth-opening measurement. Following surgery, time intervals when the patients first need to receive the drug were measured. RESULTS: The VAS scores of the patients were lower in the side treated with DT than that in the paracetamol treated side. There was no significant difference between the groups in terms of mouth-opening limitation. MRI recordings revealed that swelling was lower in the side treated with paracetamol than DT treated side. CONCLUSIONS: Administration of the drugs before surgery contributed to the postoperative patient comfort. The analgesic activity of 12.5 mg dose of DT was similar to, even better than, the analgesic activity of 500 mg dose of paracetamol; however, DT had insufficient anti-inflammatory efficacy.

[Evaluation of efficacy of radiofrequency thermal ablation technique by computed tomography and visual analog scale in treatment of isolated inferior turbinate hypertrophy]. / Izole alt konka hipertrofisi tedavisinde radyofrekans termal ablasyon teknigi etkinliginin bilgisayarli tomografi ve görsel analog ölçegi ile degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the efficacy of radiofrequency thermal ablation (RFTA) technique by computed tomography (CT) and visual analog scale (VAS) in patients with isolated inferior turbinate hypertrophy. PATIENTS AND METHODS: Between May 2009 and December 2009, 30 patients (10 females, 20 males; mean age 31.0±12.0 years; range 18 to 61 years) who were diagnosed with an isolated inferior turbinate hypertrophy were included in this study. As a treatment, RFTA was applied to the inferior turbinate on three separate points. Evaluation of turbinate dimensions was performed by CT in pre- and postoperative period. Also, the evaluation of turbinate dimension by another otorhinolaryngologist and of the nasal obstruction by the patients in pre- and postoperative period through VAS were asked. RESULTS: The mean dimensions of the left and right inferior turbinate on CT in pre- and postoperative period were 112.42±28.41 / 81.53±22.57 and 117.72±27.85 / 86.53±23.66 mm2, respectively. The mean VAS values of the left and right turbinate dimensions were determined by another otorhinolaryngologist in pre- and postoperative period as 6.60±2.48 / 4.30±1.47 and 7.60±1.67 / 4.63±1.40, respectively. The mean VAS values of nasal obstruction in pre- and postoperative period were 6.77±1.19 and 3.57±1.46, respectively. CONCLUSION: Radiofrequency thermal ablation technique used for the treatment of the inferior turbinate hypertrophy is an effective procedure in the light of the CT and VAS evaluation results.

Unusual manifestations of pediatric neuromyelitis optica.

Neuromyelitis optica is a rare, severe idiopathic disease that predominantly involves optic nerves and spinal cord. Main clinical features of neuromyelitis optica are visual loss, paraparesis or tetraparesis, sensory loss, and sphincter dysfunction. A 13-year-old girl with vision loss and behavioral change was admitted. Her behavioral changes concerned demanding everything, eating cacik (a kind of meal prepared by yogurt) continuously, calling everyone "father," and self-throttling during the last 1 month, and blurred vision started 15 days ago. On cranial magnetic resonance imaging (MRI), multiple lesions were seen. The patient was admitted 40 days later with walking difficulty. There were lesions in the medulla and cervical spinal cord on MRI. Neuromyelitis optica was diagnosed. Vomiting was the beginning complaint in 2 of 5 hospitalizations later. We conclude that neuromyelitis optica may involve atypical symptoms such as behavioral change and vomiting. Atypical presentations may delay diagnosis. Vomiting may be a recurrence messenger.

Cerebral infarction caused by traumatic carotid artery dissection.

Traumatic carotid artery dissection, if not diagnosed and treated early, is a serious problem with permanent neurological deficit and a high mortality rate of up to 40%. We present a case with delayed diagnosis of traumatic carotid artery dissection in a 21-year-old female. While there were no ischemic infarct findings on the admission cerebral computerized tomography (CT), such findings were observed on two cerebral CTs taken because of the left hemiplegia noticed seven days later when the patient regained consciousness. The patient was referred to our emergency service, and definitive diagnosis was achieved with arterial Doppler ultrasonography, cerebral magnetic resonance imaging (MRI), diffusion MRI, and MR angiography. We did not consider invasive treatment since the neurological damage was permanent and dissection grade was IV according to angiography findings. The case was discharged within a week and physiotherapy was advised. Despite the advances in diagnostic methods, diagnosis of traumatic carotid artery dissection is still missed or delayed, as in the case presented here. Early diagnosis can ameliorate permanent neurological damage or even prevent it. However, the vital factors for early diagnosis are the obtained anamnesis leading to appropriate radiological examinations, detailed physical examination and high clinical suspicion.

The mandibular landmarks about the facial artery and vein with multidetector computed tomography angiography (MDCTA): an anatomical and radiological morphometric study / Puntos de referencia de la mandíbula relacionados a la arteria y vena facial con angiografía por tomografía computarizada multidetector (ATCM): un estudio morfométrico anatómico y radiológico

The aim of this study was to investigate the course of the facial vessels according to several mandibular landmarks in living individuals using multidetector computed tomography angiography (MDCTA) to determine these related to sex and side. This study was conducted in the Radiology Department, Meram Faculty of Medicine, Necmettin Erbakan University (Konya, Turkey). In total, sixty faces from 30 specimens (15 males and 15 females) with symptoms and signs of vascular disease were evaluated for the facial vessels by MDCTA scan. The facial vessel parameters were measured according to the reference points (mandibular angle, mental protuberance, mental foramen and facial midline). The distance from the point at which the facial artery first appears in the lower margin of the mandible to the mandibular angle for right and left facial artery were observed as 3.53+/-0.66 cm and 3.31+/-0.73 cm in males, respectively. These distances were determined as 2.91+/-0.52 cm and 3.35+/-0.48 cm in females. MDCTA is a new, powerful, safe and noninvasive test to demonstrate the vasculature of the head. Bony structures and neighboring vessel morphology can be evaluated by this technique in cases of trauma with suspected vessel injuries and when considering patient selection for flap surgery.

El objetivo de este estudio fue investigar el curso de los vasos faciales de acuerdo con varios puntos de referencias mandibulares en sujetos vivos mediante angiografía por tomografía computarizada multidetector (ATCM) para determinar si éstos están relacionados con el sexo y el lado. El estudio se llevó a cabo en el Departamento de Radiología, Facultad de Medicina de Meram en Necmettin Erbakan (Konya, Turkey). En total, sesenta caras de 30 sujetos (15 hombres y 15 mujeres), que presentaban síntomas y signos de la enfermedad vascular fueron evaluados para explorar los vasos faciales por ATCM. Los parámetros sobre los vasos faciales se midieron en relación a puntos de referencia (ángulo de la mandíbula, proceso mental, foramen mental y línea mediana facial). La distancia desde el punto en el que la arteria facial aparece por primera vez en el margen inferior de la mandíbula hasta el ángulo mandibular de la arteria facial derecha y izquierda fueron 3,53+/-0,66 cm y 3,31+/-0,73 cm en hombres, respectivamente. En mujeres fueron 2,91+/-0,52 cm y 3,35+/-0,48 cm. La ATCM es un examen nuevo, poderoso, seguro y no invasivo para demostrar la vascularización de la cabeza. Las estructuras óseas y la morfología de los vasos vecinos pueden ser evaluados por esta técnica en casos de trauma con sospecha de lesiones de los vasos y se puede considerar de selección en pacientes para realizar cirugías de colgajo.

Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding.

OBJECTIVE: This study was undertaken to investigate cut-off value of the endometrial thickness by transvaginal ultrasonography (TvUSG), and to detect the accuracy of preoperative Pipelle biopsy in premenopausal women with abnormal vaginal bleeding. STUDY DESIGN: This study was included 144 premenopausal women with abnormal bleeding. Their endometrial thickness was measured by TvUSG and then Pipelle endometrial biopsy was performed. Preoperative histopathologic findings of 57 women who were operated were compared with final histolopathologic examination. RESULTS: Of the 144 women, 113 (78.4%) had normal and 31 (21.6%) had an abnormal endometrium. The abnormal endometrium was composed of 11.8% hyperplasia (simple + atypical complex), 4.2% endometrial polyp, and 5.5% adenocarcinoma. An optimal sensitivity and specificity (83.6 and 56.4%, respectively) and negative predictive value with 95.6% for detection of abnormal endometrium were obtained with an endometrial thickness of 8 mm. The accuracy rate of preoperative Pipelle biopsy was 94.7% in a total of 57 women. CONCLUSION: An endometrial thickness >8 mm is more likely than that of 8 mm or less to be indicated with endometrial biopsy in premenopausal uterine bleeding. Pipelle endometrial biopsy is an accurate diagnostic procedure for the detection of high-grade endometrial lesions in premenopausal women.

[An analysis of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging]. / Menisküs tasmasi ve beraberinde görülen diz eklemi lezyonlarinin manyetik rezonans görüntüleme ile degerlendirilmesi.

OBJECTIVES: We investigated the frequency of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging (MRI) in patients with meniscal tears. METHODS: We retrospectively evaluated MRI findings of 100 patients (41 males, 59 females; mean age 54 + or - 10 years; range 27 to 76 years) with meniscal tears in 126 knee joints. Using coronal images, extrusion was defined as a distance of = or > 3 mm between the peripheral border of the meniscus and the edge of the tibial plateau. All the knees were assessed with respect to the localization and type of meniscal tear and extrusion, accompanying joint effusion, cruciate ligament pathologies, and degenerative bone and cartilage changes. RESULTS: Meniscal extrusion was detected in 31 knee joints (24.6%), with a mean extrusion of 3.72 mm. All extrusions were found to be in the posterior horn of the medial meniscus and were associated with radial tears (n=18, 58.1%), radial-oblique tears (n=9, 29%), complex tears (n=2, 6.5%), and flap tears (n=2, 6.5%). Meniscal tears with extrusion differed significantly from those without extrusion with respect to the localization of all the tears being in the posterior horn of the medial meniscus (100% vs. 60%) and the higher frequency (58.1% vs. 20%) of radial tears (p<0.05). There were no significant differences in the types and frequencies of accompanying pathologies seen in meniscal tears with and without extrusion (p>0.05). CONCLUSION: Meniscal extrusion is a common finding particularly in osteoarthritis. It is mostly seen in the medial meniscus and accompanied by radial tears. Therefore, its presence should alert to the possibility of a radial tear extending to the meniscal root.

Assessment of myometrial invasion in endometrial cancer by transvaginal sonography, Doppler ultrasonography, magnetic resonance imaging and frozen section.

OBJECTIVE: We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler ultrasonography (TV-CDU). METHODS: This prospective study included 64 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU. RESULTS: Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion. CONCLUSIONS: Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.

The morphometric analysis of the V2 and V3 segments of the vertebral artery: normal values on MDCT.

A potential hazard in midline posterior fossa craniectomy may be the injury of vertebral artery. That's why vertebral artery evaluation prior to surgery may prevent dangerous complications. Advancements in multidetector computed tomography (MDCT) have provided detailed demonstration of the vertebral artery at the craniocervical junction and its relationships with atlas and axis. We aimed to define the normal anatomic relationship of the V2 and V3 part of the vertebral artery on MDCT. In total, 33 patients underwent MDCT angiography scan with suspected cranial aneurysm. V2 and V3 segments of vertebral artery were evaluated. Eight measurements (B, C, D, E, G, H, X, and Y line) were taken from MDCT images. For B and C, a line initially passing through the body of axis and spinous process and determining the midline was formed. Then, the vertical distance of vertebral artery from the level of transverse foramen of axis and loop to this midline was measured. For D and G, the vertical distance of vertebral artery to the midline from the upper and lower margin levels of transverse foramen of atlas was measured after a line establishing the midline passing through the anterior and posterior tubercles of atlas was drawn first. For E, transverse diameter of vertebral artery was measured at the loop level of V2 segment. For H, the vertical distance at the point where vertebral artery entered dura in the line passing from the midline of foramen magnum at anterior-posterior plane was measured. For X and Y, two different points of horizontal part of the vertebral artery were determined. One of these two points was the lateral one which was the origin of the horizontal part in the transverse foramen, the other was the intersection point on atlas. Average distances for both sides from transverse foramen of the axis, the loop of axoatlantal part and the lower border of the atlas of the vertebral artery to the midline were 20.97 mm on the right, 22.29 mm on the left; 27.19 mm on the right, 28.34 mm on the left; and 25.75 mm on the right and 27.21 mm on the left, respectively. Average distances for both sides from the upper border of the atlas, and at its penetration through dura were 27.40 mm on the right, 28.94 mm on the left; and 10.90 mm on the right and 10.93 mm on the left, respectively. Distances between spinous process and intersection of vertebral artery with horizontal part were 35.79 mm on the right and 36.63 mm on the left laterally, and 22.27 mm on the right and 22.62 mm on the left medially. MDCT angiography is a powerful test to demonstrate the vasculature of the head and neck. Bony structures and adjacent vessel morphology can be evaluated by this technique. The evaluation of craniocervical region prior to surgery with MDCT may be helpful to avoid intraoperative vascular injuries.

Anatomic and radiologic analysis of the atlantal part of the vertebral artery.

The horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial tip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (alpha) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/-S.D.) was 82.42+/-10.34 degrees and 83.21+/-10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean alpha angle was 81.64+/-10.15 degrees on the right and 83.77+/-10.65 degrees on the left. These angles varied with the position of the head.

Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: imaging features.

Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

A new reversible ischemic neurologic deficit model in dogs.

BACKGROUND: The aim of this study was to produce an internal carotid artery (ICA) occlusion model in dogs that can be used for studying the effects of surgical revascularization procedures. MATERIAL/METHODS: After left frontoparietal craniectomy, the ICA and arterial circle of the brain were coagulated and transected, letting the middle cerebral artery be perfused by the contralateral ICA by way of the rostral cerebral artery in five mongrel dogs. Magnetic resonance imaging (MRI) and brain single-photon emission computed tomography (SPECT) were performed during the first 24 to 48 hours and 7 to 10 days after the operation. Paired t and Wilcoxon matched pair tests were used for statistics (p<0.05). RESULTS: All the dogs had postoperative hemiparesis that returned to normal after 7 to 10 days. Early MRI showed cerebral ischemia in the left parietal cortical area extending to the subcortical white matter, sparing the basal ganglion and the internal capsule. Early brain SPECT demonstrated hypoperfusion corresponding to the same area. This area became significantly restricted to a small cortical area in late MRI and SPECT images (p<0.05). CONCLUSIONS: It is concluded that, as symptoms resolved spontaneously, this model can be used as a "reversible ischemic neurological deficit" model for diagnostic imaging and pharmacological studies.

A case of Burkitt lymphoma re-presenting as periportal hepatic and multiple organ infiltration.

Burkitt lymphoma (BL) is a high-grade, B-cell-originated pediatric malignancy that is a type of non-Hodgkin lymphoma involving different organs. Mediastinal mass, ascites, peritoneal thickening, and infiltration of the small intestine, kidney, and liver were found in our patient. In this case, we describe the radiologic appearances and possible infiltration patterns of multi-organ BL. Also, we discuss infiltration of the periportal area, such as hypodense lesions in the liver, which is rarely seen in BL.