Cerebrospinal fluid velocity changes of idiopathic scoliosis: a preliminary study on 3-T PC-MRI and 3D-SPACE-VFAM data.

OBJECTIVES: To the best of our knowledge, there is no study on 3-Tesla (3-T) phase-contrast MRI (PC-MRI) and three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE-VFAM) in the evaluation of idiopathic scoliosis. This study aimed to investigate CSF abnormalities in the scoliotic spine using 3-T PC-MRI and 3D-SPACE-VFAM techniques. METHODS: Thirty-four patients and 14 controls were examined with spinal PC-MRI and T2-weighted 3D-SPACE-VFAM techniques. Inter- and intra-reader agreements of flow-void phenomenon on 3D-SPACE-VFAM images, and velocity values on PC-MRI data were also evaluated. RESULTS: There are statistically significant differences between scoliosis and control groups based on the highest and mean peak velocity values on PC-MRI images (p = 0.005 and p = 0.023, respectively). The main thoracic (MT) group's highest peak CSF velocity values were higher than the control group (p = 0.022). There is a significant difference between the patient and control groups regarding flow-void phenomenon scores on 3D-SPACE-VFAM images (p = 0.036). Inter- and intra-reader agreement values related to PC-MRI velocity measurements were perfect for all PC-MRI readings. Inter- and intra-reader agreement values of the flow-void phenomenon scores were moderate. CONCLUSIONS: Our study has led us to conclude that idiopathic scoliosis is associated with CSF flow disturbances in parallel with the literature. MRI can demonstrate these abnormalities in a non-invasive and radiation-free way.

Ectopic TSH-secreting Pituitary Adenoma in Nasopharyngeal Region.

Objective: TSH-secreting pituitary adenomas (TSH-omas) are very rare disorders. This report describes the diagnosis and treatment of a thyroid-stimulating hormone-secreting ectopic pituitary adenoma in the nasopharyngeal region. Subjects and Methods: We report a 37-year-old male patient with thyroid-stimulating hormone-secreting ectopic pituitary adenoma in nasopharyngeal region. Results: A patient suffering from sweating, palpitations, dizziness and abnormality in thyroid tests was referred to our clinic. Thyroid function tests showed high basal levels of free thyroxine (FT4), free tri-iodothyronine (FT3), and serum TSH. TRH stimulation test results indicated blunted response. Scintigraphy showed increased radionuclide uptake (iodine-123), and a thyroid ultrasound scan revealed diffuse enlargement of the thyroid gland. A pituitary MRI indicated a normal pituitary. However, MRI showed a mass in the nasopharynx that was confirmed with endoscopy. Endoscopic total endonasal resection was done and the mass was removed. The pathology reported a TSH-secreting pituitary adenoma. Conclusion: In this report, an identified case of thyroid-stimulating hormone-secreting ectopic pituitary adenoma in nasopharyngeal region is reported and it is the only tenth case in the literature indicated in the nasopharyngeal region. Ectopic TSH-omas should be considered during inappropriate secretion of TSH as a candidate cause to enable correct diagnosis and improve the treatment of patients.

Is FDG-PET/CT used correctly in the combined approach for nodal staging in NSCLC patients?

BACKGROUND: The most widely accepted approach nowadays in nodal staging of non-small cell lung cancer (NSCLC) is the combined use of 18-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). However, this approach may not be sufficient, especially for early stages. AIMS: Our aim was to assess whether more satisfactory results can be obtained with standardized uptake value maximum lymph node/standardized uptake value mean mediastinal blood pool (SUVmax LN/SUVmean MBP), SUVmax LN/Primary tumor, or a novel cut-off value to SUVmax in this special group. SUBJECTS AND METHODS: Patients with diagnosed NSCLC and underwent FDG-PET/CT were reviewed retrospectively. 168 LNs of 52 early stage NSCLC patients were evaluated. The LNs identified in surgery/pathology reports were found in the FDG-PET/CT images. Anatomic and metabolic parameters were measured. Statistical analysis was performed by using of MedCalc Statistical Software. RESULTS: Regardless of LNs size; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SUVmax >2.5 were 91.5%, 65.9%, 58.2%, and 95.1%, respectively. Optimum cut-off value of SUVmax was >4.0. Sensitivity, specificity, PPV, and NPV were found as 81.0%, 90.0%, 81.0%, and 90.0% respectively. Optimum cut-off value of SUVmax LN/SUVmean MBP was >1.71. Sensitivity, specificity, PPV, and NPV were found as 94.7%, 80.0%, 71.1%, and 96.7%, respectively. Optimum cut-off value of SUVmax LN/Primary tumor was >0.28. Sensitivity, specificity, PPV, and NPV were found as 81.1%, 85.1%, 72.9% and 90.1%, respectively. CONCLUSION: SUVmax LN/SUVmean MBP >1.71 has higher PPV than currently used, with similar NPV and sensitivity. This can provide increase in the accuracy of combined approach. In this way, faster nodal staging/treatment decisions, cost savings for healthcare system and time saving of medical professionals can be obtained.

Symptomatic remission and neurocognitive functioning in patients with schizophrenia.

BACKGROUND: A cross-sectional study was conducted in participants with schizophrenia to explore a potential association between the patients' remission status and neurocognitive functioning and to examine whether these factors have an impact on functional outcome. METHOD: Psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale with symptom remission being assessed by applying the severity component of the recently proposed remission criteria. Tests for the cognitive battery were selected to cover domains known to be impaired in patients with schizophrenia. Next to pre-morbid intelligence, attention performance, executive functioning, verbal fluency, verbal learning and memory, working memory and visual memory were assessed. The joint effect of remission status and neurocognitive functioning on treatment outcome was investigated by logistic regression analysis. RESULTS: Out of 140 patients included in the study, 62 were symptomatically remitted. Mean age, education and sex distribution were comparable in remitted and non-remitted patients. Remitted patients showed significantly higher values on tests of verbal fluency, alertness and optical vigilance. Both symptomatic remission as well as performance on tests of working memory and verbal memory had a significant effect on the patients' employment status. CONCLUSIONS: In the present study neuropsychological measures of frontal lobe functioning were associated with symptomatic remission from schizophrenia. In addition, both symptomatic remission and performance on tests of working memory and verbal memory had a significant effect on the patients' employment status. Longitudinal follow-up data are needed to determine how the associations of these determinants of functional outcome interact and change over time.

Anxiety and depression in Turkish breast cancer patients.

PURPOSE: we investigated the anxiety and depression rates in breast cancer patients (BCPs) and compared their rates with a group of unemployed women attending courses at a local government agency to increase their chances for employment. METHODS: a total 129 BCPs were included [60 were treated and followed up in Marmara University Hospital (PHG), 69 were from a private oncology clinic (POG)] and 101 healthy people (control group; CG) came from a course for the unemployed. All participants completed the Turkish-language version of the Hospital Anxiety and Depression Scale. RESULTS: The mean ages of the BCPs and CG were 52.7 ± 13.1 and 38.9 ± 11.9 years, respectively (p=0.001). Compared to the CG, the percentage of housewives was significantly higher in the BCP group (p=0.04). These 2 factors (age and profession) were not independent factors predicting anxiety or depression (p>0.05). The rates of anxiety and depression were 27.9 and 35.7% for BCP, 28.7 and 34.7% for CG, 33.3 and 51.7% for PHG, and 23.2 and 21.7% for POG, respectively. The difference of the rates of depression between the POG and the PHG was significant (p=0.0001). CONCLUSION: the anxiety and depression rates were not higher in BCPs than in the CG who had a risk factor (such as unemployment) for psychosocial ill health. Being treated and/ or followed up in a private office was related to lower depression rates.

Choroidal thickness measurements in children with isolated growth hormone deficiency.

PurposeThe aim of this study was to determine the choroidal thickness measurement values in cases with isolated growth hormone deficiency (IGHD), to compare them with the healthy control group by using enhanced depth imaging optical coherence tomography (EDI-OCT), and to evaluate the effect of growth hormone (GH) treatment on choroid.Patients and methodsIn this study, 23 cases who were diagnosed with IGHD as a study group and 46 healthy subjects as a control group were included. All patients and controls underwent a complete ophthalmologic examination, including an examination with EDI-OCT. Choroidal thickness (CT) was measured at the fovea and at 1000 µm intervals from the foveal center in both temporal and nasal directions.ResultsThe mean subfoveal choroidal thickness (SFCT) was 329.04±88.49 µm in the cases with IGHD and 365.35±50.48 µm in the control group (P=0.033). The mean CT at temporal 1 and 2 mm were thinner in the IGHD group than that of control group (P=0.033 and P=0.043, respectively). Nasal quadrant measurements were also found to be thinner in the IGHD cases than that of control group, but the difference was not statistically significant. We found a significant positive correlation between pubertal staging and SFCT (rs=0.607, P=0.006). There was no statistically significant difference in CT values of the study group between before and 12 months after GH treatment (P>0.05).ConclusionThis study shows patients with IGHD has a thinner CT when compared with healthy pediatric cases. GH treatment seems to be not associated with the choroidal development.

[Meningococcal meningitis in adults]. / Eriskinlerde meningokoksik menenjit.

The clinical and laboratory findings, and the results of treatment of 16 Meningococcal meningitis cases, who were hospitalized, are investigated, and discussed with the literature. On application all of the patients had headache, meningeal irritation findings, and fever (% 75), nausea and vomiting (% 62.5), rash (% 56.25), unconsciousness (% 50), coma state (% 31.25), Herpes labialis (% 31.25), affecting of cranial nerves (% 12.5), arthritis (% 12.5), and carditis (% 6.25). At the peripheric blood examinations, all had leucocytosis, and neutrophilia. In the direct examination of the cerebrospinal-fluid, in 15 patients gram negative diplococci were seen, and in 11 patients the microorganisms grew on culture. The patients were given Crystalized-Penicillin in doses of 20-30 million IU/day. In the two cases some complications, resistance, and allergy developed, so the treatment changed. Only a patient died, and in the other cases no relapse and sequel were seen.

[Incidence of oral candidiasis in diabetic patients]. / Diabetik hastalarda oral kandida insidansi.

Yeast infections play an important role in diabetics. Therefore poorly controlled diabetics and diabetics who have high levels of serum glucose carry a high risk. In the present study, 52 diabetics aged between 17-75 years old have been investigated by means of the incidence of oral candida and have been compared with control group of 33 healthy individuals. In poorly controlled diabetics, the rate of candida growth found high. It is also observed that this ratio is higher in type I than type II, and candida growth rate increased as well as serum glucose level. All of these results are found to be statistically important.

Desenlace de 102 pacientes con linfoma de Hodgkin menores de 5 años / Outcome of 102 patients under 5 years of age with Hodgkin lymphoma

Antecedentes. El linfoma de Hodgkin (LH) es uno de los tipos de cáncer pediátrico con más posibilidades de curación. Sin embargo, es raro entre los niños menores de 5 años, y aún se desconocen los factores pronósticos de la supervivencia debido a su baja frecuencia en este grupo etario. Objetivos. El objetivo de este estudio fue evaluar las características clínicas, los esquemas de tratamiento y el desenlace de los pacientes con LH menores de 5 años. Métodos: se realizó una evaluación retrospectiva de los pacientes con diagnóstico de LH entre 1972 y 2013. Todos los pacientes recibieron quimioterapia, con o sin radioterapia. Resultados. Participaron 102 pacientes; la mediana de edad fue de 4 años (intervalo: 2-4,9). La mediana de seguimiento fue de 13 años. Veintitrés pacientes tenían síntomas B, 15 pacientes tenían neoplasia maligna con gran masa tumoral, y los estadios I y II fueron los más frecuentes. Las tasas de supervivencia global (SG) fueron significativamente diferentes según el estadio del cáncer (p = 0,008). Si bien no se observaron diferencias estadísticamente significativas, la presencia de neoplasia maligna con gran masa tumoral y de síntomas B estuvo asociada con un mal pronóstico. Conclusión. En este estudio unicéntrico se incluyó la mayor cantidad de pacientes con LH menores de 5 años. El estadio fue el principal factor de predicción de SG; por otro lado, la presencia de síntomas B y neoplasia maligna con gran masa tumoral también afectó el pronóstico.

Background. Hodgkin's lymphoma (HL) is one of the most curable pediatric cancers, however it is rare among children under five years of age and prognostic factors for survival rate are still unknown due to low frequency in this age group. Objectives. The aim of this study was to evaluate clinical characteristics, treatment regimens, and outcome of patients under five years of age with HL. Methods. Patients diagnosed with HL between 1972 and 2013 were retrospectively evaluated. All patients were treated with chemotherapy with or without radiotherapy. Results. There were 102 patients with a median age of 4 years (range: 2 to 4.9). The median followup time was 13 years. Twenty-three patients had B symptoms, 15 patients had 'bulky disease' and the most common stages were stage I and II. Overall survival (OS) rates were significantly different according to the stage of the cancer (p = 0.008). Although there were no statistically significant differences; the positivity of 'bulky disease' and B symptoms were associated with poor prognosis. Conclusion. Our single-center study included the largest number of patients under five years of age with HL. The stage was the main predictor for OS; on the other hand, the presence of B symptoms and bulky disease has also affected the prognosis.

The effects of zoledronic acid and hyperbaric oxygen on posterior lumbar fusion in a rabbit model.

We studied the effects of hyperbaric oxygen (HBO) and zoledronic acid (ZA) on posterior lumbar fusion using a validated animal model. A total of 40 New Zealand white rabbits underwent posterior lumbar fusion at L5-6 with autogenous iliac bone grafting. They were divided randomly into four groups as follows: group 1, control; group 2, HBO (2.4 atm for two hours daily); group 3, local ZA (20 µg of ZA mixed with bone graft); and group 4, combined HBO and local ZA. All the animals were killed six weeks after surgery and the fusion segments were subjected to radiological analysis, manual palpation, biomechanical testing and histological examination. Five rabbits died within two weeks of operation. Thus, 35 rabbits (eight in group 1 and nine in groups 2, 3 and 4) completed the study. The rates of fusion in groups 3 and 4 (p = 0.015) were higher than in group 1 (p < 0.001) in terms of radiological analysis and in group 4 was higher than in group 1 with regard to manual palpation (p = 0.015). We found a statistically significant difference in the biomechanical analysis between groups 1 and 4 (p = 0.024). Histological examination also showed a statistically significant difference between groups 1 and 4 (p = 0.036). Our results suggest that local ZA combined with HBO may improve the success rate in posterior lumbar spinal fusion.

Spinal extradural compression caused by granuloma of brucellosis.

A rare case of extradural brucellosis granuloma in the thoracic region is presented. In spite of medical treatment, total paraplegia with sphincter disturbance developed. Delayed neurosurgical intervention resulted in significant clinical recovery. Magnetic resonance imaging was useful in obtaining detailed information and to decide on surgery.

Conservative treatment of diabetic foot infections.

Foot infections commonly occur in diabetic patients, constituting a serious problem. 15% of diabetic have foot infections during their life-time. In previous years these life- threatening infections in 50-70% of patients resulted in limb amputation. Today, using an aggressive surgical approach, broad spectrum antimicrobial chemotherapy and intensive regulation of blood glucose level, the amputation rate has decreased to 5%. During the last 2 years, we evaluated 13 diabetic foot infections. 6 of the presented cases were grade 4 and 5, 3 of them grade 3 and 4 of them grade 2. All of the patients were managed by multidisciplinary approach consisting of plastic and reconstructive surgery, endocrinology and infectious diseases specialists. All of the patients were monitored with daily wound care, regulation of blood glucose levels and administration of broad spectrum antibiotics. Only one of them required amputation. For 12 of the cases after the infection was controlled, the defects were reconstructed by plastic surgical procedures. We retrospectively analysed them to review diabetic foot infections and factors affecting prognosis.

Mentosternal pterygium with teratoma.

A 7-year-old girl with a cervical midline pterygium and teratoma is presented. Pterygium (congenital webbing) of the skin is a rare congenital anomaly. Teratomas are tumors formed by pluripotential primordial germ cells that constitute heterogeneous types of tissues foreign to the organ from which they originate. The undefined connection of two conditions of pterygium and teratoma in the cervical region is reviewed in this case report.

Anetoderma secondary to generalized granuloma annulare.

Anetoderma is a rare disorder of cutaneous atrophy with loss of dermal elastic tissue. Secondary anetoderma is seen after a variety of dermatoses. We describe a 33-year-old woman with secondary anetoderma after generalized granuloma annulare lesions that were most pronounced on sun-exposed areas.

Type I necrotising fasciitis of heel in a diabetic patient.

Necrotising fasciitis is a potentially fatal clinical disease caused by infection with various bacteria. Diabetes mellitus, one of the predisposing factors for necrotising fasciitis is also an important factor in the progression of the illness by increasing its morbidity and mortality rate. In this case report, a 54 year old diabetic woman with type-I necrotising fasciitis of the heel was treated with extensive debridments, broad spectrum antimicrobial therapy and intensive regulation of blood glucose levels. The resulting new positive data pertaining to the morbidity and mortality of this severe disease suggest that the old management of this disease should be re-examined.