Treatment of large intracranial aneurysms using the Woven EndoBridge (WEB): a propensity score-matched analysis.

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB Consortium database, from 2011 to 2022, across 30 academic institutions globally. Propensity score matching (PSM) was employed to compare small and large aneurysms on baseline characteristics. A total of 898 patients were included. There was no significant difference observed in clinical presentations, smoking status, pretreatment mRS, presence of multiple aneurysms, bifurcation location, or prior treatment between the two groups. After PSM, 302 matched pairs showed significantly lower last follow-up adequate occlusion rates (81% vs 90%, p = 0.006) and higher retreatment rates (12% vs 3.6%, p < 0.001) in the large aneurysm group. These findings may inform treatment decisions and patient counseling. Future studies are needed to further explore this area.

Laryngopyocele: signs on computed tomography.

A laryngocele is an air-filled dilation of the saccule of the larynx. An infected laryngocele is called a laryngopyocele. Our experience with a case of laryngopyocele with signs on computed tomography before and after antibiotic therapy is presented since laryngopyocele is more unusual.

Characteristics of penetrating abdominal firearm injuries in children.

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.

Measurement of testicular volume by ultrasonography.

Twenty-five patients with scrotal hernia and hydrocele were studied. The testicular sizes of the patients were measured by using ultrasonography and the sliding caliper was used for calculations during surgery. The actual testicular volumes and those obtained by ultrasonography were not statistically different (p > 0.05). It is suggested that ultrasonography may be an alternative to orchidometers.

Sexual dimorphism and handedness in the human corpus callosum based on magnetic resonance imaging.

The corpus callosum (CC) is a major anatomical and functional commissure linking the two cerebral hemispheres. With MR imaging in the sagittal plane, the corpus callosum can be depicted in great detail. Mid-sagittal magnetic resonance images of 80 normal individuals were analyzed to assess whether or not the morphology of the corpus callosum and its parts are related to sex and handedness. The subjects were 40 males (20 right-handers and 20 left-handers) and 40 females (20 right-handers and 20 left-handers). The midsagittal area of the corpus callosum was divided into seven sub-areas using Witelson's method. The most striking morphological changes concerned left-handers, who had larger areas of the anterior body, posterior body and isthmus than right-handers. In addition, right-handed males had larger rostrums and isthmuses than right-handed females. These significantly increased areas were related to handedness in right-handed males. However, left-handed males had larger anterior and posterior bodies than right-handed males. In contrast, there was no significant difference between left-handers and right-handers in females. The areas of the rostrum and posterior body of the corpus callosum increased significantly with sex in males. Moreover, there were no significant age-related changes in the total corpus callosum and sub-areas of the corpus callosum. In conclusion, these anatomical changes in corpus callosum morphology require taking the sexual definition and dominant handedness into consideration.

Normal configuration of the anterior commissure of the glottis on magnetic resonance imaging.

The purpose of this study was to evaluate the normal width of the anterior commissure of the glottis by measuring its dimensions in patients who had no laryngeal disease on magnetic resonance imaging (MRI), but had unrelated cervical pathology. In all, 27 patients were studied. Axial images through the arytenoid commissure at the level of the vocalis muscle and/or vocal process of the arytenoid cartilage were magnified on MRI. The anteroposterior width of the anterior commissure was measured by using an electronic ruler having 1-mm marks. The average width of the anterior commissure was 1.59 +/- 0.6 mm, varying from a minimum width of 1 mm to a maximum width of 3 mm. The width was less than or equal to 2 mm in 25 patients (92.5%). Our results showed that all of the patients studied had measurable mucosal thicknesses at the level of anterior commissure > or = 1.0 mm.

Castleman's disease in the porta hepatis.

We report the CT, ultrasonographic, and pathologic features of a localized forms of Castleman's disease in the porta hepatis due to their unusual location. Our report suggests that the CT and the ultrasonographic features of Castleman's disease in these locations without calcifications is nonspecific.

Limb reconstruction with the callus distraction method after bone tumor resection.

The callus distraction method was applied to nine patients who were referred to us because of a bone tumor. Their mean age was 17 years and 3 months (range 7-37 years). Three were female, and 6 were male. All of the tumors were localised on the femur, and the histological diagnosis was two chondrosarcomas, one Ewing's sarcoma, three osteosarcomas, one giant cell bone tumor, and the remainder benign fibrous histiocytoma. The mean length of the defect after resection of the tumor was 11.5 (range 8-20) cm. Preoperative and postoperative chemotherapy were applied to patients with osteosarcoma and Ewing's sarcoma. The patients were followed up for 22 (range 15-30) months on average. The mean period of use of the external fixator was 12.5 (range 8-18) months. One patient suffered a tumour recurrence and died after 20 months. Complications included one deep infection, one skin invagination, and one premature consolidation and bone bridge in the defect area. All of the complications were successfully treated. Functional evaluation gave excellent results in four patients, good in three, and fair in two. This method can be used without any need for massive autogenous bone graft in repairing defects of any length and diameter produced after excision of the lesion and thus can be considered as an alternative to other techniques.

Lumbar epidural brucellar abscess causing nerve root compression.

OBJECTIVES: To evaluate the usefulness of MR sequences for the differential diagnosis of spinal brucellar abscesses which mimic lumbar disc herniation. METHODS: We analyzed six patients with brucellar abscesses who had symptoms mimicking lumbar disc herniation. The study group consisted of three women and three men who were 15-67 (mean = 37) years old. Patients were imaged in the axial and sagittal planes with a I.0-T MR scanner using a spine coil. RESULTS: The level of abscesses were accurate in 100% (six of six) of patients with MR imaging. MRI examinations revealed an extradural soft tissue mass which were iso- to hypointense compared to spinal cord on T1WI and hyperintense on T2-weighted images. By contrast study, diffuse homogeneous or slightly heterogeneous enhancements were seen. CONCLUSION: Lumbar extradural brucellar abscess can have lumbar disc disease symptoms. MRI may non-invasively and rapidly reveal the presence of spinal abscess and degree of extension to the spinal canal. Extradural brucellar abscess should be included in the differential diagnosis of radicular symptoms caused by disc herniation.

CT of the brain in tuberculous meningitis. A review of 289 patients.

PURPOSE: In this retrospective study, CT findings of 289 patients with tuberculous meningitis (TBM) are presented and diagnostic criteria are discussed. MATERIAL AND METHODS: The medical records of patients who were diagnosed as having central nervous system tuberculosis were investigated. Cranial CT investigations of 289 patients with TBM were reviewed. Of these 289 patients, 214 were children and 75 adults; 157 patients were male and 132 were female. CT images were obtained with and without i.v. contrast administration. RESULTS: CT findings were normal in 35 patients and abnormal in 254. The abnormalities were hydrocephalus (172 children, 32 adults), parenchymal enhancement (56 children, 6 adults), contrast enhancement of basal cisterns (32 children, 17 adults), cerebral infarct and focal or diffuse brain edema (29 children, 10 adults), and tuberculoma (9 children, 5 adults). CONCLUSION: CT is pathologic in the great majority of patients with TBM and is helpful in assessing the complications associated with the disease.

Effect of chemotherapeutic agents on distraction osteogenesis. An experimental investigation in rabbits.

Limb-salvage operations such as vascularised or non-vascularised osseous grafts and allograft and callus distraction methods have replaced amputations because of the increase in the life expectancy of patients with malignant tumours. In this study we aimed to evaluate the effects of chemotherapeutic agents on distraction osteogenesis. For this purpose, 23 rabbits randomly divided into two groups were included in the study. The experimental group and the control group consisted of 12 rabbits and 11 rabbits, respectively. The experimental group were administered chemotherapeutic agents with the protocol identified in the osteogenic sarcoma regimen. All the subjects were corticotomised in the metaphyseal-diaphyseal region, and both groups underwent distraction with a circular ring fixator. X-ray films, bone scintigraphy and histopathological examination were performed three times during the study. No difference between the two groups was observed in radiological, scintigraphical and histopathological studies carried out before the distraction period and following the end of the distraction period. In this study, it was shown that the use of antineoplastic drugs has no significant negative effect on distraction osteogenesis applied for reconstruction in rabbits. We think that it can be an alternative treatment method in humans as well.

Spinal subdural tuberculous abscess.

OBJECTIVES: Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess. METHOD: Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination. RESULTS: The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. Dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained. CONCLUSION: Tuberculosis may cause a spinal subdural abscess and although it is a rare disorder, when encountered MRI is very useful in the diagnosis.

Tuberculous peritonitis in 11 children: clinical features and diagnostic approach.

BACKGROUND: Tuberculous peritonitis (TBP) is a rare manifestation of childhood tuberculosis characterized by long-lasting abdominal symptoms and exudate and lymphocytes in the ascitic fluid. The diagnosis of TBP is rarely established unless a high index of suspicion is maintained. METHODS: The diagnostic features of 11 cases who were hospitalized with TBP in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Turkey, were evaluated retrospectively. RESULTS: Seven cases were male and the ages of all cases ranged between 1 and 11 years. The onset of symptoms was 1-12 months (mean +/- SD 3.1 +/- 2.7 months) prior to the admission time. Nine patients gave a history of familial tuberculosis. Three cases had Bacillus Calmette-Guérin (BCG) scars and the results of five tuberculin unit (TU) tests in cases without and with BCG were over 10 and 15 mm, respectively. The most common presenting clinical symptoms and signs at admission were abdominal distention and ascites (100%), fever (27%) and loss of weight (18%). One case had accompanying tuberculous meningitis and two cases had concomitant pulmonary tuberculosis. Only one of 11 samples of ascitic fluid yielded Mycobacterium tuberculosis by the polymerase chain reaction method and no other microbiologic evidence was obtained in culture specimens. Ultrasonographic and computed tomographic imagings revealed high-density ascites that contributed well to the diagnosis. The diagnosis in two patients was proven histopathologically via peritoneoscopy and laparoscopy. All cases were treated with isoniazide, rifampisin for 9 months and pyrazinamide for the first 2 months. CONCLUSIONS: Radiologic diagnostic techniques, positive skin tests and a history of exposure to tuberculosis may contribute to the diagnosis of TBP, helped by clinical symptoms and findings, particularly when invasive diagnostic methods via peritoneoscopy and laparoscopy are not available in developing countries.