Effect of Chronic Valproic Acid Use on Anterior Cerebral Blood Flow of Children with Idiopathic Generalized Epilepsy.

OBJECTIVE: Cerebral blood flow has been blamed as a factor in the negative effect of antiepileptic drugs on neurocognition. This study aimed to investigate whether valproic acid (VPA), used for the treatment of idiopathic generalized epilepsy (IGE), causes a change in cerebral blood flow in children. METHODS: Included in this study were 33 children who were receiving VPA for IGE and 34 age-matched controls. Doppler and spectral measurements in common carotid artery (CCA), left and right internal CA (ICA) and external CA (ECA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) were performed and the maximum velocity (VM), end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI) and flow rate (FR) were calculated. RESULTS: The mean age of drug and control groups were 9.33 plus or minus 2.11, and 9.74 plus or minus 2 years, respectively. Follow-up of patients was 17.7 plus or minus 3.2 months. The period of VPA treatment was 17.4 plus or minus 3.4 months. No statistically significant differences were found between control and VPA group for the VM, EDV, RI, PI, and FR values obtained from the bilateral ICA, ACA, and MCA. CONCLUSIONS: The results showed that VPA in therapeutic doses did not affect anterior cerebral blood flow. However according to result, it is still difficult to conclude that neurocognitive deterioration is not observed in patients receiving VPA.

Shear wave versus strain elastography in the differentiation of benign and malignant breast lesions

Background/aim: To evaluate and compare the diagnostic performances of shear wave elastography (SWE) and strain elastography (SE) in the differentiation of benign and malignant breast lesions. Materials and methods: The current study included 87 breast lesions in 84 patients. The Breast Imaging Reporting and Data System (BIRADS) categories were determined with ultrasound features. The maximum shear wave velocity (SWV), mean SWV, maximum SWV to fat SWV ratio, and mean SWV to fat SWV ratio were measured using SWE. The strain ratio (SR) was calculated as the ratio of lesion strain to the adjacent fat strain using SE. Receiver operating characteristic (ROC) curves were constructed to assess and compare the diagnostic performances of each parameter. Results: Forty-five benign and 42 malignant lesions were diagnosed. The sensitivity and specificity of the BIRADS classification was 100% and 35.6%, respectively. Selecting a cutoff SR value of 3.22 led to an 88.1% sensitivity and an 88.4% specificity (AUC: 0.913 [95% CI: 0.854­0.971], P < 0.001). Selecting cutoff maximum SWV value of 3.41 m/s led to an 88.1% sensitivity and an 86.7% specificity (AUC: 0.918 [95% CI: 0.858­0.978], P< 0.001). The diagnostic performance of the maximum SWV, mean SWV, and maximum SWV to fat SWV ratio were similar to the diagnostic performance of the SR (P = 1.00, P= 1.00, P= 0.629, respectively). Conclusion: SE and SWE are both feasible imaging modalities in the differentiation of malignant and benign breast lesions with similar diagnostic performances.

Diagnostic value of ultrasonography in peroneal neuropathy

Background/aim: Peroneal neuropathy at the fibular head (PNFH) is one of the most common entrapment neuropathies. Our aim in this study was to analyze the efficiency of ultrasonography in the diagnosis of PNFH. Materials and methods: The study included 15 peroneal nerves of 12 patients with PNFH and 24 peroneal nerves of 12 healthy controls. PNFH confirmation was based on clinical and electrophysiological findings. All patients and controls underwent ultrasonographic evaluations for peroneal nerves. The cross-sectional area (CSA) was measured. Echogenicity of the nerve was evaluated by comparing it with the adjacent connective tissue deep under the subcutaneous fat. Results: CSA measurement of the peroneal nerve is a valuable diagnostic tool in predicting PNFH (AUC: 0.87, 95% CI: 0.73­1.00, P < 0.01). The CSA cutoff value for diagnosing PNFH was found to be 0.115 cm 2 with 80% sensitivity and 99% specificity. Hypoechoic peroneal nerve in patients with PNFH was very frequent. Conclusion: Ultrasonography is a useful technique in diagnosing PNFH. In addition to clinic and electrophysiological findings, it may improve diagnostic performance.

Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases: Presentation of Ondokuz Mayis scoring system.

PURPOSE: To evaluate the predicting factors for non-sentinel lymph node (SLN) metastases in T1-2 invasive breast cancer with 1-2 metastatic SLN that fully matched the ACOSOG Z0011 criteria. Also, to develop a scoring system to predict the risk of non-SLN metastasis and to discriminate the low-risk patients for omission of the axillary lymph node dissection (ALND) in this population. METHODS: Two hundred and seven T1-2 invasive breast cancer patients with 1-2 metastatic SLN who underwent ALND at our Institution were included in the study. Independent factors predicting the non-SLN metastasis were found using logistic regression analysis, and a scoring system to predict the non-SLN metastasis was created. RESULTS: Seventy (34%) out of 207 patients had non- SLN metastasis. Multivariate logistic regression analysis demonstrated that tumor size, presence of lymphovascular invasion (LVI), number of negative SLNs, and size of SLN metastasis were independent factors predicting non-SLN metastasis. There were 68 (33%) and 108 (52%) patients with a the score of ? 4 (predicted probability of ?10%) with a false negative rate (FNR) of 4.4%, and ?5 (predicted probability of ?15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93). CONCLUSIONS: The present Ondokuz Mayis model with an AUC of 0.88 showed excellent discrimination capacity to distinguish patients at low risk for positive non-SLN from high risk patients and could help spare ALND in an important portion of patients.

Erratum: Factors predicting non-sentinel lymph node metastasis in T1-2 invasive breast cancer with 1-2 axillary sentinel lymph node metastases:Presentation of Ondokuz Mayis scoring system.

In this article published in Volume 21, issue 5, the Results section of the Pubmed abstract appeared as: "There were 68 (33%) and 108 (52%) patients with a the score of ? 4 (predicted probability of ?10%) with a false negative rate (FNR% of 4.4%, and ?5 (predicted probability of ?15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93%)." The correct Results section of the abstract is: "There were 68 (33%) and 108 (52%) patients with a the score of ≤4 (predicted probability of ≤10%) with a false negative rate (FNR) of 4.4%, and ≤5 (predicted probability of ≤15%) with a FNR of 7.4%, respectively. The area under the curve (AUC) value for the Ondokuz Mayis scoring system was 0.88 (95% CI 0.83-0.93)." This error appeared only in the PubMed database and not in the print form of the Journal.

Comparison of oversized artery and vein grafts for interpositional pedicle lengthening in rat femoral artery.

Vessel grafting is commonly used for revascularization or pedicle lengthening. Although veins are more commonly used, they can form aneurysms when bridging an arterial gap. This can lead to thrombosis, and the risk is increased when there is a size discrepancy. This study reports the long-term results of arterial lengthening via size discrepant carotid artery and femoral vein grafts in a rat femoral artery model (1:1.5 ratio). A total of 28 rats were used in this study, divided into two groups of 14. By the 21st day, one anastomosis in each group has been found to be thrombosed. Long-term patency rates were the same for both groups (93.3%). Radiologic imaging showed that size match in the carotid artery grafts was excellent despite of slightly fusiform dilatation, but in the vein groups, pronounced aneurismal deformation and distortion in the anastomosis was seen. Histologic analysis revealed that in the arterial grafts, endothelial continuity was smooth and mural inflammation was less than that of the vein grafts. Organized or recanalized mural thrombi were seen in 38.5% in the vein grafts, whereas in arterial grafts there were none.

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Neuromuscular Electrical Stimulator as a Protective Treatment against Intensive Care Unit Muscle Wasting in Sepsis/Septic Shock Patients.

OBJECTIVE: To investigate the efficacy of neuromuscular electrical stimulation (NMES) application in preventing muscle wasting in intensive care unit (ICU) patients diagnosed with sepsis/septic shock. STUDY DESIGN: A single-centre, unblinded, parallel-group, prospective, randomised clinical study. PLACE AND DURATION OF STUDY: Ondokuz Mayis University, Faculty of Medicine Hospital, Level 3 ICU, between October 28th 2018, and October 1st, 2020. METHODOLOGY: Eighty patients from a single centre who were diagnosed with sepsis/septic shock, followed up at level 3 ICU, and met the criteria were included. The patients were evaluated in 2 groups: One who received physiotherapy alone (n=40) and the other who received physiotherapy + NMES (n=40). The development of intensive care unit-muscle wasting was evaluated in patients of both groups. Muscle wasting was identified by anthropometric and ultrasonographic measurements. The day the patients were diagnosed with sepsis was determined as the first day and the bilateral anthropometric and ultrasonographic measurements of the biceps brachii and rectus femoris muscles were obtained on days 3, 7, 14, 21, and 28. RESULTS: There was no significant difference between the groups in the ultrasonographic and anthropometric measurements on days 1, 3, and 7 (p>0.005). However, the ultrasonographic measurements of the group that received physiotherapy + NMES demonstrated a significantly lower loss in the upper extremities on days 14 and 21 compared to the group that received physiotherapy alone (p=0.003 and p=0.028, respectively). No significant difference was found in the anthropometric measurements. CONCLUSION: The NMES, which have been increasingly used as new treatment protocols in the prevention of ICU-AW, yield favourable results in patients with sepsis/septic shock. KEY WORDS: Intensive care unit, Acquired weakness, Neuromuscular electrical stimulation, Muscle wasting, Sepsis.

The relationship between migraine and right-to-left shunt in children.

UNLABELLED: Migraine is the most common headache in childhood, and there are some reports that suggest the relationship between migraine and right-to-left shunt. The aim of this study was to evaluate the frequency of right-to-left shunt in children with migraine with aura and compare it with children with migraine without aura, and in healthy children. In a cross-sectional case-control study, we assessed 20 children with migraine with aura, 20 migraine without aura and 20 healthy age, and gender-matched control group. We determined the frequency of right-to-left shunt by transcranial doppler with contrast and transthoracic echocardiography without contrast. The dopplers and echocardiograms were performed blindly by the same examiners during headache-free periods. The presence of right-to-left shunt was found in 13/20 patients with migraine with aura compared with five of 20 migraine without aura and four of 20 control subjects. The frequency of right-to-left shunt in migraine with aura was statistically different from the other two groups (P < 0.005). There was no association between right-to-left shunt and frequency of attacks, duration and intensity of attacks, uni/bilateral occurence, familial occurrence, gender and age of patients. CONCLUSION: our findings suggest possible association of migraine with aura and right-to-left shunt. It seems that right-to-left shunt does not influence the clinical features of migraine.

Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity.

The aim of this study was to determine the diagnostic value of ultrasonographic measurements in ulnar neuropathy at the elbow (UNE) and to assess the relationship between the measurements and the electrophysiological severity. The largest anteroposterior diameter (LAPD) and cross-sectional area (CSA) measurements of the ulnar nerve were noted at multiple levels along the arm, and the distal-to-proximal ratios were calculated. Almost all of the measurements and swelling ratios between patients and controls showed statistically significant differences. The largest CSA, distal/largest CSA ratio, CSA at the epicondyle, and proximal LAPD had larger areas under the curve than other measurements. The sensitivity and specificity in diagnosing UNE were 95% and 71% for the largest CSA, 83% and 85% for the distal/largest CSA ratio, 83% and 81% for the CSA at the epicondyle, and 93% and 43% for the proximal LAPD, respectively. There was a statistically significant correlation between the electrophysiological severity scale score (ESSS) and the largest CSA, the CSA at the epicondyle and 2 cm proximal to the epicondyle, and the LAPD at the level of the epicondyle (P < 0.05). None of the swelling ratios showed a significant correlation with the ESSS. The largest CSA measurement is the most valuable ultrasonographic measurement both for diagnosis and determining the severity of UNE.

Feasibility and safety of antegrade radial artery cannulation.

BACKGROUND AND OBJECTIVE: The purpose of this study was to compare thrombosis rates in antegrade (catheter directed toward the hand) versus retrograde (catheter directed toward the elbow) cannulation of the radial artery. Our secondary objectives were to compare these two techniques in terms of success rate, differences in noninvasive versus invasive blood pressure measurement and complications. METHODS: After obtaining the approval of the local ethics committee and written informed consent, the patients were randomly allocated to the antegrade (group A, n=60) or retrograde (group R, n=60) groups. Arterial thrombosis was evaluated by ultrasonography in each patient. Noninvasive and invasive blood pressure measurements and complications were recorded. Data were analysed using Student's t-test, the Mann-Whitney U-test, the categorical chi test, Fisher's exact test and Bland-Altman analysis. RESULTS: Thrombosis rates were similar between groups. The success rates for cannulation were 86.7 and 96.7% in the antegrade and retrograde groups, respectively (P<0.05). Complication rates were similar between groups. Very significant correlation was observed between the invasive and noninvasive methods when simultaneously measuring arterial systolic, diastolic and mean blood pressure. However, antegrade arterial measurements were consistently lower than those obtained via noninvasive methods. CONCLUSIONS: We conclude that antegrade radial artery cannulation has no advantage over the retrograde approach in terms of reducing thrombosis, but it can be used in cases when the retrograde approach has failed.

Focal liver lesions: whether a standard dose (0.05 mmol/kg) gadobenate dimeglumine can provide the same diagnostic data as the 0.1 mmol/kg dose.

OBJECTIVE: Gadobenate dimeglumine (Gd-BOPTA) is a liver-specific contrast agent also showing a distribution in the extracellular compartment which is recommended to be used at standard dose (0.05 mmol/kg) in magnetic resonance imaging (MRI) of liver lesions. However, its use at 0. 1mmol/kg is gradually increasing in recent clinical practice. Which dose should we use in routine MRI of liver lesions from now on? This study investigated the efficacy of Gd-BOPTA at a standard dose versus 0.1 mmol/kg dose in demonstrating diagnostic data in MRI of focal liver lesions. MATERIALS AND METHODS: The study included 47 patients with focal liver lesions. Twenty-two patients received standard dose and 25 patients received 0.1 mmol/kg dose Gd-BOPTA intravenously. MRI of both groups was carried out with T1-A FLASH-2D and T2-A TURBO spin echo before contrast injection and T1-A FLASH-2D sequences in dynamic and late phase (90th minute) after the contrast injection. The lesion conspicuity for each image was evaluated qualitatively. Liver signal to noise ratio (SNR), absolute lesion-liver contrast to noise ratio (CNR), mean lesion-liver CNR and contrast enhancement rate of the liver obtained from both groups were compared quantitatively. RESULTS: While liver contrast enhancement rate in the group receiving standard dose Gd-BOPTA were 41%+/-42 in the arterial phase, 66%+/-58 in the portal phase, 45%+/-45 in the venous phase and 42%+/-88 in the late phase, these values were 43%+/-59, 86%+/-73, 63%+/-75 and 61%+/-105, respectively, in the group receiving the dose of 0.1 mmol/kg. There were no statistically significant differences between the means of both groups. While the absolute lesion-liver CNR values were 18+/-15 precontrast, 22+/-18 in the arterial phase, 19+/-17 in the portal phase, 15+/-10 in the venous phase and 24+/-26 in the late phase in the group receiving the standard dose Gd-BOPTA, these values were 13+/-11, 18+/-15, 15+/-15, 13+/-13 and 19+/-21, respectively, in the group receiving the 0.1 mmol/kg dose. There were no statistically significant differences between the means of both groups (p>0.05). However, when the mean lesion-liver CNR values were compared, there was statistically significant difference between each arterial and portal phases of metastases in both groups (p<0.05). There was no statistical difference found in other lesions. When lesion conspicuity scores were compared, there were no significant differences between the two groups. CONCLUSION: In liver lesions, similar diagnostic data are obtained in dynamic and late phase MRI with either standard dose Gd-BOPTA or with a dose of 0.1 mmol/kg. Because there was a difference in only metastases in both groups, in oncological patients who are being investigated for liver metastasis, it is expedient to use a dose of 0.1 mmol/kg.

A comparison of low-dose and normal-dose gadobutrol in MR renography and renal angiography.

OBJECTIVE: It has been advocated that a reduced injection volume with highly concentrated (1 M) contrast material can produce a sharper bolus peak and an increased intravascular first-pass gadolinium concentration when compared with the use of a lower concentration (0.5 M). A higher concentration would also cause a reduction in dose. The purpose of our study was to test the use of a low dose (0.05 mmol/kg) of gadobutrol in magnetic resonance renography and angiography and compare the findings with a dose of 0.1 mmol/kg. MATERIALS AND METHODS: One-hundred-thirty-four patients referred for magnetic resonance angiography for suspected renovascular disease participated in the study. Contrast enhanced MR renography and angiography were performed after administration of a bolus of 0.1 mmol/kg or 0.05 mmol/kg gadobutrol in randomized patients. The relative signal intensity-time curves of the aorta, peripheral cortex and parenchyma, were obtained. Two radiologists evaluated the angiographic images and evaluated the quality of angiography. RESULTS: The signal intensity with a low dose of gadobutrol was significantly lower in early phases, in the peripheral cortex (for 36, 54, 72 and 90 seconds), the parenchyma (for 36, 54, 72 seconds) and the aorta (for 18, 36, 54, 72 seconds). The decreases in the early phase obtained with a low dose of gadobutrol caused blunter time intensity curves. The difference in the quality scores of the readers for the angiographic images for the use of the two different doses was not statistically significant (p > 0.05). CONCLUSION: A lower dose of gadobutrol can be used for MR renal angiography, but for MR renography the normal dose should be used.

Bifid median nerve in patients with carpal tunnel syndrome.

OBJECTIVE: The aim of this study was to investigate the frequency of the anatomic variation of a bifid median nerve in patients with carpal tunnel syndrome (CTS) and to determine the size criteria for sonography. METHODS: On axial sonograms of 320 hands of 170 patients with CTS and 240 hands of 120 unaffected individuals, the median nerve was evaluated morphologically for a bifid median nerve, and the cross-sectional area was measured at 3 levels (radial-ulnar junction, pisiform, and hook of the hamate). Electrophysiologic studies were performed in addition to clinical and sonographic evaluations in all patients, controls with a bifid median nerve, and controls with a cross-sectional area of greater than 0.09 cm(2). RESULTS: A bifid median nerve was seen in 32 (19%) of 170 patients and 11 (9%) of 120 controls. It occurred relatively frequently in patients with CTS (P < .01). The cross-sectional area of the bifid median nerve was relatively higher than that of the nonbifid median nerve in controls at 2 of the 3 levels (P < .001; P = .226; P < .01). The cutoff values for the cross-sectional area at the level of the pisiform were 0.11 cm(2) (sensitivity, 90%; specificity, 99%; P < .001) for patients with a bifid median nerve and 0.10 cm(2) (sensitivity, 98%; specificity, 81%; P < .001) for patients with a nonbifid median nerve. CONCLUSIONS: A bifid median nerve occurs relatively frequently in patients with CTS. It may facilitate compression of the median nerve in the carpal tunnel because of its relatively higher cross-sectional area compared with a nonbifid median nerve. The size criterion for CTS in patients with a bifid median nerve is slightly higher than in those with a nonbifid median nerve.

Idiopathic isolated laryngotracheobronchial cartilage calcification in a child.

Laryngeal, tracheal, and bronchial cartilage calcification is quite rare in children. It was reported to occur in congenital cardiovascular diseases, Keutel syndrome, chondroplasia punctata, warfarin embryopathy, and warfarin sodium therapy. It can occur idiopathically as well. Laryngotracheobronchial cartilage calcification is demonstrated in this report by chest radiography and multiplanar three-dimensional CT examination in a 2.5-year-old boy with nonspecific cough.

Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography. PATIENTS AND METHODS: The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization. RESULTS: A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages. CONCLUSION: Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.

Efficacy of Sonoelastography in Distinguishing Benign from Malignant Breast Masses.

OBJECTIVE: The study aimed to evaluate the influence of sonoelastographic strain ratio in distinguishing benign from malignant breast masses. MATERIALS AND METHODS: Patients who were referred for diagnostic biopsy of a breast mass were examined by ultrasound and sonoelastography prior to percutaneous biopsy. Sonoelastography was performed twice by the same observer in the same session. The strain ratios (SR) were calculated for both measurements as well as the mean strain ratio. Results were compared with histopathologic findings. For each strain ratio, a threshold value was determined using a ROC analysis for the differentiation of benign and malignant masses. RESULTS: After histopathological examination of 135 mass lesions in 132 female patients (mean age 48±12 years), 65 masses were diagnosed as benign and 70 as malignant. According to the Tsukuba classification with 5 scores; 44 of 65 benign masses had scores of either 1 or 2 while 56 of 70 malignant lesions had scores of either 4 or 5. No benign lesion was classified as score 5, and no malignant lesion as score 1. The mean cut-off in the two ROC measurements in distinguishing benign from malignant lesions was calculated as 4.52. When a threshold value of 4.52 was used for the mean strain ratio: the sensitivity, specificity, PPV, NPV, and accuracy rates were determined as 85.5%, 84.8%, 85.5%, 84.8% and 85.2%, respectively. CONCLUSION: The threshold value for strain ratio in the differentiation of benign and malignant masses was detected as 4.52, and a significant intra-observer difference was not observed in this study. The diagnostic value of sonoelastograghy in distinguishing benign from malignant breast masses was higher in comparison to conventional ultrasound.

Dyggve-Melchior-Clausen syndrome without mental retardation (Smith-McCort dysplasia).

Radiographic features of a 15-year-old boy with Smith-McCort dysplasia are presented. Dyggve-Melchior-Clausen syndrome without mental retardation has clinical and radiographic findings similar to those of Smith-McCort dysplasia. Both of these syndromes are rare autosomal recessive disorders affecting skeletal development. The radiographic appearance of generalized platyspondyly with double-humped end-plates, and the lace-like appearance of iliac crests are pathognomonic and distinctive of these syndromes. Diagnostic features of these diseases are compared with others like Morquio's disease and spondylometaphyseal dysplasia, which may have similar vertebral changes, and are discussed in the light of the literature.

Diagnostic value of ultrasonography in the evaluation of blunt abdominal trauma.

PURPOSE: To evaluate the diagnostic value of ultrasonography (US) in detecting intraabdominal injuries in patients with blunt abdominal trauma. MATERIALS AND METHODS: Blunt trauma patients admitted to the emergency department from January 2002 to August 2003 were retrospectively evaluated. A total of 454 patients with blunt abdominal trauma who underwent US examination were included. Ultrasonography results were compared with findings of CT, diagnostic peritoneal lavage, laparotomy and clinical course. Sensitivity, specificity, positive and negative predictive values of US in detecting free fluid, intraabdominal parenchymal organ injury or both were calculated. RESULTS: Computed tomography, diagnostic peritoneal lavage and laparotomy results showed that intraabdominal organ injury was present in 37 of 454 patients. Ultrasonography examinations were positive in 51 patients. True-positive findings were seen in 32 of these patients. In these 32 patients, US examination showed free fluid in 19, fluid and abdominal organ injury in 11 and only abdominal organ injury in 2. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US in detecting intraabdominal injury were 86.5%, 95.4%, 62.7%, 98.7% and 94.7%, respectively. CONCLUSION: Ultrasonography has high diagnostic performance in the screening of patients with blunt abdominal trauma. Abdominal US is a useful and valuable diagnostic tool after clinical evaluation in patients with blunt abdominal trauma. Because of its high negative predictive value, we recommend that clinical follow up is adequate for patients whose US results are negative for intraabdomial organ injury.