Idiopathic Granulomatous Mastitis Associated with Erythema Nodosum.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. CASE REPORT: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with indrawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. CONCLUSION: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones.

Successful Localization of Abnormal Parathyroid Gland Using Ultrasound-Guided Methylene Blue Dye Injection in the Reoperative Neck.

Persistent or recurrent hyperparathyroidism is a challenging problem for endocrine surgeons. The aim of this study was to review our experience using ultrasound-guided (US-G) methylene blue dye injection for the localization and removal of abnormal parathyroid glands in patients having primary hyperparathyroidism and previous neck surgery. Between January 2012 and May 2013, six consecutive patients with primary hyperparathyroidism (PHPT) and previous neck surgery underwent focused parathyroidectomy with the use of US-G methylene blue dye injections to localize the presumed parathyroid adenoma were included in the study. We analyzed the data of six patients who underwent reoperative parathyroid surgery using US-G methylene blue dye injection retrospectively. The dye injection was performed just prior to surgery. All patients were successfully treated for their hyperparathyroidism which was confirmed by at least 50 % drop in intraoperative parathormone level 10 min after resection. There were no complications related with US-G dye injection or with surgery. US-G methylene blue dye injection is a cheap, safe, and effective method for localization of diseased parathyroid glands and guiding surgery in the reoperative neck.

Diffusion-weighted magnetic resonance imaging findings of kidneys with obstructive uropathy: differentiation between benign and malignant etiology.

PURPOSE: In this study, we aimed to evaluate the capability of diffusion-weighted magnetic resonance imaging (DWI) in differentiation between benign and malignant etiology of obstructive uropathy. MATERIALS AND METHODS: DWI was performed in 41 patients with hydronephrotic kidneys and 26 healthy volunteers. MR imaging was performed using a 1.5 T whole-body superconducting MR scanner. The signal intensities of the renal parenchyma on DWI and apparent diffusion coefficient (ADC) maps were noted. DWI was performed with the following diffusion gradient b values: 100, 600, and 1000 s/mm(2). A large circular region of interest was placed in the corticomedullary junction of the kidneys. For statistical analysis, the independent-samples t test was used. RESULTS: The mean renal ADC values for b100, b600, and b1000 in hydronephrosis patients with benign and malignant etiology and the healthy volunteers of the control group were analysed. ADC measurements of renal parenchyma in all hydronephrotic kidneys with benign and malignant etiology were found to be statistically low compared to those of normal kidneys (P < 0.05). CONCLUSIONS: There were significant differences in the ADC values of obstructed kidneys compared to those of normal kidneys. Obstructed kidneys with malignant etiology had lower ADC values for b1000 compared to obstructed kidneys with benign etiology, but these alterations were statistically insignificant.

[Assessment of the effects of surgical treatment options for cubital tunnel syndrome on the ulnar nerve by USG and EMG]. / Kübital tünel sendromunda cerrahi tedavi seçeneklerinin ulnar sinir üzerine etkilerinin USG ve EMG ile degerlendirilmesi.

OBJECTIVES: The morphology and functional results of the ulnar nerve were evaluated in patients treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome. PATIENTS AND METHODS: Thirteen elbows of 13 patients (8 males, 5 females; mean age 41 years; range 25 to 56 years) treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome were investigated. The involvement was on the dominant side in six patients. There was a 25° cubitus valgus deformity in one patient. No significant etiologic cause was found in the other patients. Seven patients were treated with anterior subcutaneous transposition and six with simple decompression. During the follow-ups, the atrophy magnitude, the new pressure areas and the intrinsic structure of the nerve tissue along the ulnar nerve path were evaluated by using soft tissue ultrasonography (USG). The flow rate of the artery supplying the ulnar nerve by Doppler mode USG and ulnar nerve conduction rate by electromyography (EMG) were assessed. Functional results were evaluated according to the Akahori's criteria and the modified Bishop scoring system. The average follow-up time was two years (range 12-44 months). RESULTS: In the Doppler USG examination, no arterial blood flow supplying the ulnar nerve was found in five of seven patients who underwent anterior transposition. A blood flow decrease of approximately 20 cm/s was found in two patients. A blood flow decrease of 10 cm/s on average was found in six patients who underwent simple decompression. There was a significant difference between the two groups (p<0.05). The control EMG revealed an increase of 9 m/s in the ulnar nerve conduction rate in the transposition group (p>0.05) and an increase of 17 m/s in the simple decompression group compared to the preoperative values (p<0.05). In seven patients who underwent anterior subcutaneous transposition, five excellent and two good results and an average of 8.2 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. In six patients who underwent simple decompression, five excellent results, and one good result and an average of 8.1 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. There was no statistically significant difference between functional results of both surgical techniques (p>0.05). CONCLUSION: Although the functional results of the cubital tunnel syndrome surgery are good, it must be noted that the blood supply to the nerve may be distorted, especially during anterior transposition. If there is no additional requirement, simple decompression may be considered as the first option.

Hydatid disease from head to toe.

Hydatid disease (HD) is a unique parasitic disease that is endemic in many parts of the world. HD can occur almost anywhere in the body and demonstrates a variety of imaging features that vary according to growth stage, associated complications, and affected tissue. Radiologic findings range from purely cystic lesions to a completely solid appearance. Calcification is more common in HD of the liver, spleen, and kidney. HD can become quite large in compressible organs. Hydatid cysts (HCs) can be solitary or multiple. Chest radiography, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) imaging, and even urography can depict HCs. The imaging method used depends on the involved organ and the growth stage of the cyst. US most clearly demonstrates the hydatid sands in purely cystic lesions, as well as floating membranes, daughter cysts, and vesicles. CT is best for detecting calcification and revealing the internal cystic structure posterior to calcification. MR imaging is especially helpful in detecting HCs of the central nervous system. Radiologic and serologic findings can generally help establish the diagnosis of HD, but an HC in an unusual location with atypical imaging findings may complicate the differential diagnosis. Nevertheless, familiarity with imaging findings, especially in patients living in endemic regions, is advantageous in this context.