Feasibility of virtual reality and comparison of its effectiveness to biofeedback in children with Duchenne and Becker muscular dystrophies.

INTRODUCTION/AIMS: The utilization of virtual reality (VR) and biofeedback training, while effective in diverse populations, remains limited in the treatment of Duchenne and Becker muscular dystrophies (D/BMD). This study aimed to determine the feasibility of VR in children with D/BMD and compare the effectiveness of VR and biofeedback in children with D/BMD. METHODS: The study included 25 children with D/BMD. Eight children in the control group participated in a routine follow-up rehabilitation program, while the remaining children were randomly assigned to the VR (n = 9) and biofeedback (n = 8) groups for a 12-week intervention. The following evaluations were performed before, during (week 6), and after treatment: Muscle pain and cramps, laboratory studies, muscle strength, timed performance, function (Motor Function Measurement Scale-32, Vignos, and Brooke Scales), and balance (Pediatric Functional Reach Test and Balance Master System). Motivation for rehabilitation was determined. RESULTS: The median ages were 9.00 (VR), 8.75 (biofeedback), and 7.00 (control) years. The study found no significant differences between groups in pretreatment assessments for most measures, except for tandem step width (p < .05). VR and biofeedback interventions significantly improved various aspects (pain intensity, cramp frequency, cramp severity, muscle strength, timed performance, functional level, and balance) in children with D/BMD (p < .05), while the conventional rehabilitation program maintained patients' current status without any changes. The study found VR and biofeedback equally effective, with VR maintaining children's motivation for rehabilitation longer (p < .05). DISCUSSION: The study showed that both VR and biofeedback appear to be effective for rehabilitation this population, but additional, larger studies are needed.

Dual task impact on functional mobility and interaction of functional level and balance in patients with Duchenne muscular dystrophy.

BACKGROUND: Dystrophin, a protein crucial for various brain regions governing higher-order functions like learning and memory is notably absent in individuals with Duchenne muscular dystrophy (DMD). This absence of dystrophin in the brain is believed to underlie cognitive challenges in DMD. Cognitive and motor challenges observed in DMD could potentially hinder the execution of dual tasks. RESEARCH QUESTION: Is there a significant correlation between dual-task performance, functional mobility, and balance in children with DMD? METHOD: The study included 28 participants (14 DMD, 14 typical development). Timed Up and Go (TUG) test results were recorded for single and dual-task conditions (motor-motor, cognitive-motor). Functional level was assessed using Motor Function Measurement-32 (MFM-32), Brooke Upper Extremity Scale, and Vignos Scale. Balance was evaluated using Balance Master System and Pediatric Functional Reach Test (PFRT). RESULTS: Significant differences in TUG test scores across conditions were observed in both DMD and typical development groups (p < 0.05). Children with DMD exhibited longer completion times compared to typical development children (p < 0.05). Among children with DMD, there was a significant correlation between TUG scores in different task conditions and balance assessment (p < 0.05, r = 0.571 to -0.819). Lower MFM-32 scores in DMD children were correlated with worse TUG performance across conditions (p < 0.05, r = 0.586 to -0.868). SIGNIFIANCE: This study sheds light on the multifaceted nature of dual-tasking challenges in individuals with DMD, thereby contributing to a deeper understanding of the implications for rehabilitation strategies.

Efficacy of automatic pupillometry as a screening technique to detect autonomic dysfunction in bipolar disorder.

CLINICAL RELEVANCE: Autonomic nervous system abnormalities in the pathophysiology of bipolar disorder are controversial. Pupillary features may be affected as a result of autonomic nervous system abnormalities in bipolar disorder. Small changes in pupillary responses may not be noticeable on clinical examination. Automated pupillemetries can be helpful in demonstrating these changes reliably and quantitatively. BACKGROUND: The aim of this study was to compare the static and dynamic pupillary responses of bipolar patients with healthy controls. In addition, pupillary response differences between mania, depression and remission stages were investigated. METHODS: The bipolar patient group consisted of 39 eyes of 39 patients with 13 patients in each of the stages: mania, depression and remission. The control group consisted of 39 eyes of 39 healthy volunteers. After the ophthalmic examination, static and dynamic pupillometry measurements were made. The mean pupil dilatation speed was calculated according to dynamic measurements. Static pupillometry measurements including scotopic, mesopic and photopic pupil diameters; the first dynamic measurements at 0th second and pupillary dilatation speed were used for statistical analysis. RESULTS: There was no difference static and the first dynamic pupillometry measurements between the bipolar and control groups (p > 0.05 for all parameters), but there was a significant difference in mean pupil dilatation speed (p = 0.041). No significant differences were found between the 3 groups for all static and the first dynamic pupillometry measurements and the mean pupil dilatation speed (p > 0.05). CONCLUSION: Static and the first dynamic measurements of bipolar patients were not different from healthy controls. The mean pupil dilatation speed of bipolar patients was significantly lower, but this difference had a low effect size.

An Optical Coherence Tomography Study that Supports the Neurovascular Basis of Schizophrenia Disease.

Objectives: Spectral domain optical coherence tomography (SD-OCT) is a non--penetrating, quick, and practical device which enables measurement of the chorioretinal layers. In this study, our purpose was to investigate the retinal nerve fiber layer (RNFL) and choroidal thickness in schizophrenia patients, using SD-OCT, and compare the -findings with those of the control group. Methods: For the study, 44 patients with a diagnosis of schizophrenia, and 41 age- and gender- matched healthy controls were enrolled. Both eyes of each participant were -evaluated. RNFL was measured and analyzed automatically with optical coherence tomography. Scans for choroidal thickness were obtained with the enhanced depth imaging mode of the SD-OCT device and measured manually. Results: The average age of schizophrenia patients was 47.82, and it was 45.5 for the control group. The mean illness duration of the patients was 24.79 years. According to the results of this study, all choroidal measures (nasal, subfoveal, and temporal) of both eyes, and the RNFL thickness of schizophrenia patients, were significantly thinner than that of healthy controls. The chorioretinal measures of both eyes were similar. The results showed that a weak negative correlation was present between illness duration and choroidal diameter. Conclusion: In addition to demonstrating the thinning of RNFL in schizophrenia patients, as frequently reported in the literature, the results of this study show, for the first time, that choroidal thickness is considerably decreased in schizophrenia patients compared to the healthy controls, using SD-OCT. Keeping in mind that the choroid is a vascular layer, these results support the neurovascular hypothesis of schizophrenia.

Comparison of Hospitalization Rate and Social Functioning of Patients Receiving Community Mental Health Service and Outpatient Psychiatry Policlinic.

BACKGROUND: This study aimed to compare the hospitalization rates and social functioning of patients receiving Community Mental Health Center (CMHC) services and those treated in the psychiatry policlinics of hospitals. SUBJECTS AND METHODS: A total of 145 patients who were diagnosed with schizophrenia or schizoaffective disorder according to DSM-V criteria were included in the study. Of them, 81 received CMHC services at least for one year (CMHC group) and 64 were followed-up in psychiatry policlinics (hospital group). A personal information form containing socio-demographic and disease/treatment characteristics and hospitalization counts in the last year, Social Functioning Assessment Scale (SFAS) and Positive and Negative Syndrome Scale (PANSS) were used to collect data. The hospital group received antipsychotic medication therapy while a semi-structured psycho-social intervention program combined with antipsychotic drug therapy was applied in the CMHC group. The hospitalization counts, SFAS and PANSS scores of the groups were compared and the correlation of related factors were evaluated. RESULTS: Hospitalization rates were 0.21±0.56 in the CMHC group and 1.03±1.31 in the hospital group. The mean hospitalization rate was significantly lower in the CMHC group (p<0.001). The mean scores for the overall SFAS and its interpersonal relationships and entertaining subscale; were significantly higher in the CMHC. The mean overall PANSS scores were 84.23±15.28 and 99.50±15.99 in the CMHC and hospital groups, respectively (p<0.05). There was a moderate positive relationship between hospitalization rates and all PANSS scores. CONCLUSIONS: CMHC services led to a serious decrease in hospitalization rates, increased the psychosocial functioning of patients and improved their compliance to treatment. Transition to a community-based mental health model should be accelerated for holistic treatment. Further longitudinal studies with a control group should be conducted.

Rates and correlates of employment in patients with schizophrenia: A multicenter study in Turkey.

BACKGROUND: There is not enough information regarding the participation in the working life of the patients with schizophrenia in Turkey. AIMS: The aim of this study was to examine the occupational experiences of patients with schizophrenia before and after the illness and to investigate the factors that predict work participation. METHODS: The data on occupational life of the patients with schizophrenia, which were treated as outpatients in six different centers, were examined. The rates of participation in working life before and after the disease were evaluated. Patients with and without occupational life history after the disease were compared in terms of demographic characteristics. Factors predicting participation in work life after the disease were analyzed by logistic regression analysis. RESULTS: Out of the 587 patients evaluated in the study, 73% were males, 73% were single, the mean age was 42, mean level of education was 9 years and the average duration of illness was 18 years. The duration of the employment before the disease was higher than that after the disease regarding expected working time. The rate of employment was 11% currently, 14% in the last year, 62% after the disease and 83% for the lifetime. While the factors that predicted to be in working life after the illness were male gender (odds ratio (OR) = 2.9), diagnosis of schizoaffective disorder (OR = 2.6), high level of education (OR = 1.2) and employment history before the onset of the illness (OR = 1.0), only the shorter duration of illness (OR = 1.1) predicted the current working status when the gender variable was excluded. CONCLUSION: Rate of employment of patients with schizophrenia living in Turkey was low as in other countries. Good premorbid functioning seems to determine participation in occupational life after the illness.

Importance of Sonoelastography in Assessing Non-Thyroid Neck Masses.

OBJECTIVE: To evaluate the feasibility and value of sonoelastography in assessing non-thyroid neck masses. METHODS: Non-thyroid neck masses requiring surgical interventions were evaluated using conventional B-mode ultrasonography (US) (size, short/long axis rate, shape, hilum, echogenity, calcification, necrosis, and peripheral edema) and sonoelastograpy (SE) with strain ratio (SR) and elasticity score (ES) before surgery. These parameters were compared with the histopathological examination. RESULTS: In total, 116 non-thyroid neck masses (66 lymph node, 35 parotid gland, eight submandibular gland, and seven cervical mass) of 89 patients (51 men, 38 women) with a mean age of 50.3±15.1 (19-79) years were evaluated. Thirty-seven malignant lymph nodes (23 metastatic and 14 lymphoma), seven malignant parotid tumors, two malignant submandibular tumors, 29 benign lymph nodes, 28 benign parotid lesions, and six benign submandibular lesions were evaluated. Mean SR and ES values of malignant masses were 6.3/3.2 for lymph nodes, 5.5/3.3 for the parotid gland, and 4.2/3 for the submandibular gland. Mean SR and ES values of benign lesions were 2.0/2.1 for lymph nodes, 4.4/3.2 for the parotid gland, and 3.2/3 for the submandibular gland. SR and ES were significantly higher for malignant masses compared with those for benign ones. SR was more predictive than ES in evaluating malignant lymph nodes. The area under the curve was 0.917(0.827-1.00) (p<0.05) for SR in differentiating benign-malignant lymph nodes, and the upper cut-off value was two. SR and ES were higher in the malign parotid and submandibular gland lesions than the benign ones, but the difference was not statistically significant. CONCLUSION: Strain ratio value could be a useful parameter in differentiating benign-malignant lymph nodes. More studies are necessary for differentiating benign-malignant parotid and submandibular lesions using SE.

Evaluation of subclinical atherosclerosis in migraine patients by ultrasound radiofrequency data technology: preliminary results.

OBJECTIVES: Migraine is a headache disorder affecting approximately 12% of the population, predominantly female individuals. Migraine has been associated with vascular events such as stroke and cardiovascular disease. The close connection between these vascular disorders and atherosclerosis is well known. Carotid artery intima-media thickness (CAIMT) is a marker for detection of subclinical atherosclerosis. The present study is an analysis of the presence of subclinical atherosclerosis in migraine patients. METHODS: CAIMT was evaluated in 25 female migraine patients and 27 female controls using innovative ultrasound (US) radiofrequency (RF) data technology. Mann-Whitney U test was used to compare measurements in patient and control groups. RESULTS: There was a statistically significant difference between mean CAIMT of migraine patients and control group (p<0.005): mean CAIMT was 701±114 µm in migraine patients and 400±64 µm in control group. CONCLUSION: Migraine patients are more prone to atherosclerosis compared to healthy individuals. CAIMT measurement with sonography can be utilized in follow-up to detect subclinical atherosclerosis.

Carpal tunnel syndrome: elastosonographic strain ratio and cross-sectional area evaluation for the diagnosis and disease severity.

AIM: To evaluate the role of gray scale ultrasonography (US) and real time elastosonography (RTE) in carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Both wrists of 18 healthy volunteers (n=36) formed the control group (Group 1) and 19 symptomatic outpatients of the neurology clinic constituted the patient group. According to nerve conduction study results, cases with mild CTS (n=15) formed Group 2; cases with moderate to severe CTS (n=20) formed Group 3. Cross sectional area (CSA) and strain ratio (SR) were measured at carpal tunnel inlet (CTI) and 4 cm proximal to the distal end of the radius (P). CSA and SR change score (CSACTI-CSAP; SRCTI-SRP), CSA and SR ratio score (CSACTI / CSAP; SRCTI / SRP) were calculated. RESULTS: The median nerve was significantly stiffer in Group 2 compared to Group 1; also in Group 3 compared to Group 1 (p=0.000). For CSACTI, the difference was significant between Group 1 and Group 3 (p=0.000), also between Group 2 and Group 3 (p=0.001). For CSA change scores the difference was only significant between Group 1 and Group 3 (p=0.015). In the diagnosis of CTS the best cut-off value for CSACTI was 10.8 (p=0.001), 2.3 for SRCTI (p=0.000), 4.9 for the CSA change score (p=0.005), 0.05 for the SR change score (p=0.000), 1.3 for the the CSA ratio score (p=0.015) and 1.1 for the SR ratio score (p=0.000). CONCLUSION: SR measurements do not exclude patients even with mild CTS but cannot categorize disease severity. CSA measurements on the other hand can categorize disease severity. Therefore, the combined use of US and RTE is suggested.

Foetal biometry in polyhydramnios: Does femur length fall behind?

We aimed to identify the growth patterns in polyhydramnios, and therefore evaluated 108 singleton pregnancies complicated with polyhydramnios according to the changes in biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) percentiles. The pregnancy outcomes according to the growth features were analysed. In the study population, BPD and AC percentiles exhibited a significant increase (p = 0.023 and 0.05, respectively), although FL percentiles showed a significant decrease (p = 0.006) according to the changes in third trimester relative to second trimester. In the overgrown group (n = 52), the FL/BPD ratio was lower (p < 0.001), with more foetuses with FL/BPD ratios below 71 (p = 0.05). In conclusion, there was a significant increase in BPD and AC percentiles and a decrease in FL percentiles in third trimester relative to second trimester in foetuses with polyhydramnios. However, we observed a shorter FL and a lower FL/BPD ratio without associated skeletal dysplasia in overgrown foetuses.

Renal Artery Doppler Findings in the Patients with Polyhydramnios before and after the Conservative Treatment.

OBJECTIVE: The aim of this study was to evaluate the foetal renal blood flow with colour Doppler ultrasonography. Patients with polyhydramnios were investigated for the foetal renal artery pulsatility index (PI) at the beginning of the treatment, and after the conservative treatment in those who reached the normal amniotic fluid index. MATERIALS AND METHODS: In this prospective study, 39 foetuses with polyhydramnios were evaluated at gestational weeks 26 to 36. The foetal development parameters, right and left foetal renal artery PIs, and amniotic fluid index were measured at the beginning of the treatment in all of these patients. Of these patients, 19 who responded to the conservative treatment were also revaluated when their amniotic fluid index reached normal levels, and statistical analyses were performed for the renal artery PIs before and after the treatment. RESULTS: In this study, 19 patients fulfilled the inclusion criteria as patients with polyhydramnios who responded to conservative treatment. For these patients, the mean foetal renal artery PI was 2.08 (range 1.5-3.0) at the first sonographic examination, and the mean foetal renal artery PI was 1.94 (range 1.53-2.69) after the conservative treatment. However, there was no statistically significant difference between these two groups (p=0.117). CONCLUSION: In this study, no statistically significant difference was found in the foetal renal artery PIs of the patients with polyhydramnios before and after the conservative treatment. These results suggest that the renal artery blood flow may not have any effect on the renal artery PI; therefore, these findings indicate that the renal artery PI cannot be used as a marker in the evaluation of polyhydramnios.

[The incidence of facial canal dehiscence in Bell's palsy patients]. / Bell paralizili hastalarda fasiyal kanal dehissans oranlari.

OBJECTIVES: In this study, we compared the incidence of facial canal dehiscence in patients with idiopathic peripheral facial paralysis (Bell's palsy) with a healthy population. PATIENTS AND METHODS: Forty-five patients who were defined as idiopathic peripheral facial paralysis between May 2011 and June 2012 were enrolled the study. The clinical and demographic characteristics of the patients were noted. Spiral computed tomography (CT) was used for the study with a slice thickness of 1 mm and slice gap of 0.5 mm. Fifty patients having no middle ear pathology who underwent temporal CT due to other reasons were enrolled in the study as control group. The both groups were compared by means of demographic characteristics and the presence of the facial canal dehiscence. RESULTS: The incidence of facial canal dehiscence was 42% in the control group, while the incidence of the facial canal dehiscence in the study group at the paralyzed side was 46.7%. Although the incidence of the facial canal dehiscence in the study group was higher than the control group, the difference between the groups was not statistically significant (p=0.802). When the incidence of bilateral facial canal dehiscence in the study group (22.2%) and the control group (0%) was compared, the difference between the groups was statistically significant (p<0.001). CONCLUSION: Although the incidence of the facial canal dehiscence in the patients with Bell's palsy was higher than the control group, the difference between the groups was not statistically significant. The incidence of the bilateral facial canal dehiscence of the study group was significantly higher than the healthy population.

Choroid plexus separation in fetuses without ventriculomegaly: Natural course and postnatal outcome.

PURPOSE: To evaluate fetuses with choroid plexus separation without ventriculomegaly in terms of fetal malformations, behavior of the separation during follow-up, and postnatal outcome. METHODS: In total, 172 fetuses with choroid plexus separation without ventriculomegaly were included in this prospective study. Fetal sonography was performed at 2- to 4-week intervals, and detailed physical and neurologic examinations were performed after their delivery. Fetuses were categorized into normal and abnormal subgroups according to the outcome. RESULTS: Sixteen fetuses (9.3%) were included in the abnormal-outcome group and 156 fetuses (90.7%) were included in the normal-outcome group. Both the initial mean lateral ventricular diameter (9.3 mm versus 8.6 mm) and the initial mean choroid plexus separation (4.8 mm versus 3.3 mm) were greater in the abnormal group than in the normal group (p < 0.001 for both comparisons). We found that 4.0 mm was the best cutoff point of choroid plexus separation to detect a major anomaly, with 87.5% sensitivity and 93.6% specificity. CONCLUSIONS: Choroid plexus separation without ventriculomegaly often resolves within the third trimester and does not affect postnatal outcome. It can be associated with various fetal malformations; however, with a comprehensive examination, all fetal malformations can be detected prenatally. Follow-up sonography studies would be useful, especially in the case of suspected corpus callosum agenesis.

[Angiographic evaluation of branching pattern and anatomy of the aortic arch]. / Arkus aorta anatomisinin ve dallanma paternindeki varyasyonlarin anjiyografik olarak degerlendirilmesi.

OBJECTIVE: The study aimed to investigate anatomical variations in branching pattern and anatomy of the aortic arch, and the prevalence of each type. METHODS: Between September 2011 and November 2013, angiographic studies of 270 patients (144 male, 126 female) were analyzed retrospectively for variations in branching pattern and anatomy of the aortic arch. Patient mean age was 59.8 years (range, 13-88). Branching variations were found and divided into subtypes. Patients were also classified according to arch anatomy. Incidence of variations and types of aortic arch were statistically analysed. RESULTS: Analysis of the 270 patients revealed six types of branching pattern. Type I, classical pattern arch with three branches (TB, LCC, LS), was observed in 198 cases (73.3%). Type II (bovine arch), the most commonly observed variation, in which LCC originates from TB, was observed in 58 cases (21.5%). Type III, in which the left vertebral artery arises from the arch, was seen in seven cases (2.6%). Type IV, a combination of types II and III, was observed in three cases (1.1%). Type V, common origin of common carotids, LS and aberrant RS, was found in three cases (1.1%). Type VI (avian type), arch with only two branches, was observed in one case (0.4%). When patients were classified according to aortic arch anatomy, Type 1, Type 2 and Type 3 were observed in 195, 40 and 35 patients respectively. CONCLUSION: Knowledge of the variations and anatomy of the aortic arch is essential during interventional procedures and neck-thorax surgery.

The role of elastosonography, gray-scale and colour flow Doppler sonography in prediction of malignancy in thyroid nodules.

BACKGROUND: Ultrasound is as a noninvasive method commonly used in the work-up of thyroid nodules. This study aimed to evaluate the usefulness of sonographic and elastosonographic parameters in the discrimination of malignancy. PATIENTS AND METHODS: 150 thyroid nodules were evaluated by gray-scale, Doppler and elastosonography. The cytological analysis revealed that 141 nodules were benign and 9 were malignant. RESULTS: Orientation of the nodule was the only sonographic parameter associated with malignancy (p = 0.003). In the strain ratio analysis the best cut-off point was 1.935 to discriminate malignancy (p = 0.000), with 100% sensitivity, 76% specificity, 100% negative predictive value, 78.5% positive predictive value and 78% accuracy rate. There was a statistically significant correlation between the elasticity score and malignancy (p = 0.001). Most of the benign nodules had score 2 and 3, none of them displayed score 5. On the other hand, none of the malignant nodules had score 1 and 2, most of them displaying score 5. CONCLUSIONS: A change in the diagnostic algorithm of the thyroid nodules should be considered integrating the elastosonographic analysis.

The role of elastosonography in the differentiation of parotid gland lesions: report of three cases and review of the literature.

BACKGROUND: The parotid gland is the mostly affected site among major salivary gland tumors in up to 85% of cases. Preoperative knowledge of the tumour nature is crucial since it influences the surgical procedure and patient's morbidity, especially the risk of facial nerve palsy. Ultrasonography is commonly used as the first line imaging modality for the salivary gland lesions. A pitfall is that the histologic pleomorphism often reflects an imaging pleomorphism. CASE REPORT: HEREIN WE AIMED TO PRESENT THE ROLE OF ELASTOSONOGRAPHY IN THREE PAROTID LESIONS: a case of benign pleomorphic adenoma, a Wharthin's tumour and a malignant parotid tumour. CONCLUSIONS: Our findings show that malignant parotid lesion was the stiffest lesion according to elastosonography. Wharthin's tumour demonstrated soft elastosonographic features. The pleomorphic adenoma was also interpreted as stiff by elastosonography suggesting that the elastosonographic features of pleomorphic adenoma may resemble those of malignant lesions limiting the utility of the technique.

The role of salivary gland elastosonography in Sjögren's syndrome: preliminary results.

AIM: There is a need for a reliable, noninvasive radiological method for the assessment of salivary gland changes in Sjögren's syndrome (SS). The aim of this study was to evaluate the role of elastosonography as a noninvasive, sonographic modality evaluating tissue stiffness for salivary gland involvement in SS. METHOD: We examined the stiffness in parotid and submandibular glands of 23 patients diagnosed with SS and 20 healthy volunteers. Elasticity scores of the salivary glands were classified into four groups according to the degree of the elasticity of the glands. RESULTS: The elasticity scores of the parotid and submandibular glands did not show a statistically significant difference between the patients with SS and the healthy volunteers. On the other hand, there was a significant relationship between the duration of the symptoms and the elasticity score of the parotid glands and left submandibular glands (P < 0.05). Patients with higher duration of symptoms had higher elasticity scores. CONCLUSION: The results might suggest that with the progression of the SS, the elasticity scores of the parotid glands increase gradually, indicating that ultrasonic elastosonography has the potential to demonstrate the progression of the disease. The utility of elastosonography in the follow-up of SS needs to be evaluated with larger studies.

Real time sonoelastographic evaluation of renal allografts in correlation with clinical prognostic parameters: comparison of linear and convex transducers according to segmental anatomy.

BACKGROUND: Renal transplantation is the treatment of choice in end-stage renal disease. Chronic allograft dysfunction is the leading cause of chronic allograft failure. Surveillance biopsy is the only reliable tool to detect early fibrosis in the allograft. There is a need for non-invasive methods for the detection of early development of renal allograft fibrosis. AIMS: To analyze the reliability of sonographic elasticity index and resistive index measurements in the evaluation of renal transplant fibrosis using linear and convex transducers according to segmental anatomy. MATERIALS AND METHODS: Elasticity index and resistive index were measured in 28 renal transplants and correlated with clinical prognostic parameters. Donor age above 50 years old, post transplantation time over 60 months and serum creatinine level above 1.5 mg/dl were defined as poor prognostic parameters. RESULTS: Renal transplant recipients with serum creatinine level above 1.5 mg/dl demonstrated higher mean elasticity index (p=0.006) with a convex probe and higher elasticity index in the middle segments both with a convex and a matrix linear probe (p=0.026, p=0.001). Renal transplant recipients with post-transplantation time of 60 months and more demonstrated higher resistive index values in the middle segments (p=0.016). CONCLUSIONS: Convex probe was able to detect the changes in mean stiffness better than the matrix linear probe. The measurements from subsegments might suggest that diffuse changes in stiffness can truly be detected in the middle segments or that fibrotic processes start from the middle segments of the renal transplants. Further studies correlated with histopathology are required to validate the findings.

A rare anatomical variation of the greater saphenous vein. Case report.

The venous system has frequent anatomical variations. A good understanding of the venous anatomy is very important and proper evaluation of the venous system is crucial for the appropriate treatment of venous disorders. There are many variations of the greater saphenous vein at the level of the thigh, knee and leg. All variations of the saphenofemoral junction reported in the literature refer to the drainage of the greater saphenous vein into the common femoral vein. A very rare greater saphenous vein variation at the level of the saphenofemoral junction is defined and discussed in this case report.

Evaluation of effects of bronchiectasis on bronchial artery diameter with multidetector computed tomography.

BACKGROUND: Among patients with increased bronchial artery diameter there is a significant association between hemoptysis and bronchiectasis score. The higher score of bronchiectasis, the higher risk of hemoptysis development. PURPOSE: To investigate the association of stages of bronchiectasis based on a computed tomography (CT) grading system, with bronchial artery diameter and hemoptysis in patients with bronchiectasis. MATERIAL AND METHODS: Patients with lung pathologies other than bronchiectasis, which may cause hemoptysis, were excluded from the study. One hundred and forty-five patients who underwent contrast-enhanced thorax CT by a 64-detector CT for various indications, and who were diagnosed with bronchiectasis, were evaluated retrospectively. CT examinations were carried out by two radiologists with 9 and 4 years of experience with chest radiology, respectively. The diameters of the right and left bronchial arteries were measured 1 cm from the aortic origin and perpendicular to the vessel axis. Cases were assessed based on the Bhalla CT scoring system. The hemoptysis history of every patient was taken. RESULTS: The diameters of the right and left bronchial arteries were significantly greater in patients with scores of 2 and 3 bronchiectasis than in patients with a score of 1. This was significantly greater in patients with a score of 3 than in patients with a score of 2 (P < 0.05). In patients with a score of 1, the right bronchial artery diameter was significantly greater than that of the left bronchial artery (P < 0.05). Right bronchial artery diameters were significantly greater than left bronchial artery diameters in score 3 patients (P < 0.05). A significant association was observed between hemoptysis and bronchiectasis in patients with increased bronchial artery diameter (P < 0.05). CONCLUSION: In patients with bronchiectasis, as the stage of bronchiectasis increases, the bronchial artery diameters and the risk of hemoptysis increase. We think that in patients who are diagnosed with bronchiectasis via multidetector CT (MDCT), based on scoring with bronchial artery diameters, the risk of hemoptysis can be estimated, and early management plans can be implemented.