Comparison of diffusion-weighted imaging and enhanced T1-weighted sequencing in patients with multiple sclerosis.

Introduction The purpose of this study was to assess whether demographic, brain anatomical regions and contrast enhancement show differences in multiple sclerosis (MS) patients with increased diffusion lesions (ID group) compared with diffusion restriction (DR group). Method MRI protocol comprised T1- and T2-weighted sequences with and without gadolinium (Gd), and sagittal three-dimensional FLAIR sequence, DWI and ADC maps were prospectively performed in 126 MS patients from January to December 2015. The investigation was conducted to evaluate differences in demographic, cord and brain regional, technical, and positive or negative Gd contrast imaging parameters in two groups of ID and DR. Statistical analysis was performed by using SPSS. Results A total of 9.6% of patients showed DR. In the DR group, 66.6% of the patients showed contrast enhancement of plaques, whereas 29.2% of the IR group showed enhancement of plaques. The most prevalent group was non-enhanced plaques in the ID group, followed by Gd-enhanced plaques in the ID group. Patients in the ID group (90.4%) were significantly more than in the DR group (9.6%). Out of the 40 patients with Gd-enhanced plaques, 80.5% was from the ID group and 19.5% from the DR group. Conclusion MRI of the brain, unlike of the cord, with Gd demonstrates significant difference in enhancement between the two groups ( p < 0.05). No significant difference was seen in demographic, cord and brain regional, and technical parameters, EDSS, disease duration, and attack rate as well as demographic and regional parameters between the ID and decrease diffusion groups ( p > 0.05).

Evaluation of the risk factors of pilonidal sinus: a single center experience.

BACKGROUND/AIMS: We aimed to evaluate which factors, if prevented, could facilitate a decrease in the rate of pilonidal sinus. MATERIALS AND METHODS: From November 2008 to 2010, all patients referred to the surgery clinic were examined by the general surgery attending physician. Patients with a diagnosis of pilonidal sinus were considered as the trial group. The control group included healthy persons who accompanied the patients to the clinic. Both groups completed a questionnaire form, which included age, sex, occupation, weight, height, number of baths taken per week, mean duration of sitting and driving, and family history of pilonidal sinus. The Statistical Package for the Social Sciences software was used to analyze the data. RESULTS: Positive family history was seen in 71.7% of patients compared to 23.2% of the control group. 70.7% of patients had body mass index >25, whereas only 12.9% of the control group were overweight. P value was significant for family history and body mass index >25. Long duration of sitting was seen in 66.7% of patients vs. 22.8% of the control group (p: 0.002). Long duration of driving was reported in 70.7% of the patient group compared to 24.8% of the control group (p: 0.001). Irregular hygiene of the sacrococcygeal region was noted in 74.7% of the patient group, while 40.6% of the control group took baths less than three times per week (p value was significant). Pilonidal sinus was seen in 39.4% of drivers in the patient group and in 23.8% of the control group (p: 0.012). P value was not significant between students in the patient and control groups (30.3% vs. 23.8%, respectively). CONCLUSIONS: Weight loss and regular hygiene, especially in patients with long durations of sitting and/or driving, are the suggested preventative measures to decrease the risk of disease.

Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound.

INTRODUCTION: The management of the hemodynamically stable patients with penetrating abdominal stab wounds is a problematic issue among trauma surgeons. METHODS: In a retrospective study, we analyzed stable patients with anterior abdominal stab wound from August 2009 to 2010. The patients who were hemodynamically unstable or had developed peritonitis were excluded. In our center, the patients are treated through conservative or operative management depending on the protocol of management of the stable penetrating abdominal stab wound in our center. We compared the effectiveness, mean duration of hospital admission, and the time of starting diet in 2 groups. RESULTS: There were 99 cases including 47 patients in the conservative group and 52 in the laparotomy group. The laparotomy was negative in 73% and positive in 27% of the patients. In the conservative group, all the patients remained asymptomatic and stable except for 6 patients who needed subsequent laparotomy. The maximum period between admission and delayed laparotomy in these 6 patients was 17 hours. The mean length of hospital stay and the time of starting diet were 70.4 vs 43 hours and 42.3 vs 30.6 hours in the operative group and conservative group, respectively. P < .05 was considered significant. CONCLUSION: Our study showed that conservative management of asymptomatic and stable patients with anterior abdominal stab wound with physical examination can decrease the rate of normal laparotomy and the length of hospitalization and help to start diet earlier. This study made this hypothesis that after 17 hours of observation, diet can be started for the stable asymptomatic patients.

Evaluation of intrapleural contrast-enhanced abdominal pelvic CT-scan in detecting diaphragm injury in stable patients with thoraco-abdominal stab wound: a preliminary study.

BACKGROUND: Many of the patients with thoraco-abdominal stab wound remain asymptomatic; in this regard, previous studies reported that 7-48% of asymptomatic patients had diaphragm injury (DI). Thoracoscopy or multidetector computed tomography (MDCT) scan is the best method to detect DI. We aimed to evaluate the role of CT scan with intrapleural contrast to rule out DI in stable thoraco-abdominal stab wounds. METHOD: In a prospective study, we evaluated all haemodynamically stable patients with thoraco-abdominal stab wound, from October 2009 to 2010. Exclusion criteria included patients who needed emergency thoracotomy or laparotomy, those who were haemodynamically unstable and those with blunt trauma or gunshot injury. In the CT-scan department, 500 cc of diluted meglumine diatrozate was transfused into the pleural space via a chest tube and the CT scan was performed from the dome of the diaphragm to the pelvic cavity. In the second step, all patients were taken for thoracoscopy within 24h after admission. The CT-scan slide was considered positive if one of the following signs was found: (1) the diaphragm was obviously injured as seen in CT-scan slides and (2) contrast agent was seen in the peritoneal cavity. Sensitivity and specificity were calculated for CT scan and thoracoscopy. RESULTS: Four out of 40 patients had DI according to thoracoscopy. CT scan with intrapleural contrast predicted diaphragmatic injury correctly in all four patients. Considering thoracoscopy as the gold-standard method, the CT scan had two false-positive cases. The sensitivity of the intrapleural-contrast CT scan was 100% and its specificity was 94.4%. CONCLUSION: Our study showed that CT scan with intrapleural contrast can be an acceptable approach to rule out DI and limit the use of thoracoscopy for final diagnosis and repair of DI in cases with suspicious or positive CT-scan results, especially in trauma centres with high load of trauma patients and little accessible equipment.

Liver abscess in children: a 10-year single centre experience.

BACKGROUND/AIM: Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries. MATERIALS AND METHODS: The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients' records retrospectively. RESULTS: There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscess were immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later taken for open drainage, with an overall mortality rate of 5.5%. CONCLUSION: The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to cases reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries.

Appendiceal hydatid cyst: a case report and review of literature.

Hydatid cyst has a predilection to involve liver and lungs. Most of the reported cases of appendiceal hydatid cyst are primary, and secondary involvement has been rarely reported in the English-language literature. Herein, we report a 47-year-old man who presented with abdominal pain, fatigue, and anorexia since 6 months ago. He had history of surgery for hepatic hydatid cyst 7 years ago. Diagnosis of secondary hydatidosis was made upon positive indirect hemagglutination assay and abdominopelvic computed tomography scan, which showed involvement of liver, appendix, and spleen. Albendazole was started, and surgical cystectomy, appendectomy, and splenectomy were performed. Albendazole was continued postoperatively for 6 months. During this period, liver function test and abdominal sonography were normal. Despite its rarity, our case emphasizes that primary care physicians should have high index of clinical suspicion of secondary hydatidosis of appendix when they detect cystic mass, especially in patients with previous hepatic hydatid disease.

Huge immature teratoma of the liver in an adult: a case report and review of the literature.

Teratoma tumors are tumors of childhood and, to the best of our knowledge, only 9 cases of hepatic teratoma and 1 case of immature teratoma of the liver had been reported in adults in the English literature. We present the second case of immature liver teratoma in a 22-year-old woman who presented with a 4-month history of abdominal pain and fullness sensation. A computed tomography (CT) scan of the abdomen and pelvis showed a huge well-defined heterogeneous mass in the right lobe of the liver containing fat, calcification, and cystic and solid parts, all suggestive of a teratoma. A right hepatectomy and an omentectomy were performed. The pathology report showed a 27 cm mass composed of ectodermal, mesodermal and endodermal components with minimal atypia and foci of immature components suggestive of immature teratoma, which is the largest liver teratoma to be reported. The patient was discharged in good health. During 8 months of follow-up, a CT scan and α-fetoprotein levels were both normal, and the patient is still alive.