Shear-wave elastography for detection of placenta percreta: a case-controlled study.

BACKGROUND: Prenatal diagnosis of placenta percreta (PP) is important to be able to provide effective management and a multidisciplinary approach to minimize the complications. PURPOSE: To evaluate the role of shear-wave elastography (SWE) in the prenatal diagnosis of PP. MATERIAL AND METHODS: A total of 18 women with PP and 20 pregnant women with normal placenta in the second or third trimesters were included in this prospective study. SWE was used to determine the elasticities of the placenta (in the maternal edge of the placenta) and myometrium. The obstetric data regarding grayscale and Doppler ultrasonography, and perinatal outcomes were reviewed. A mean placental SW velocity (SWV) cut-off value was determined to predict the presence of placental adherence. RESULTS: The SWV values of the PP group in the maternal edge of the placenta were significantly higher than those of the control group (1.95 ± 0.19 m/s and 1.69 ± 0.23 m/s; P = 0.001). Myometrial SWV was also higher in the PP group compared to the control group (2.25 ± 0.39 m/s and 1.90 ± 0.71 m/s; P = 0.002). A receiver operating characteristic (ROC) curve analysis was performed and the best cut-off value of placental SWV was determined as 1.92 m/s with sensitivity of 58% and specificity of 80%, to predict the placental adherence in patients with PP. CONCLUSION: Placental stiffness was significantly higher in patients with PP than in pregnant women with normally localized placenta. Thus, we thought that SWE of the placenta might be used as an alternative method in the diagnosis of PP.

Does B12 deficiency lead to change in brain metabolites in pediatric population? A MR spectroscopy study.

OBJECTIVES: The aim of this study is to examine metabolite changes in different brain regions of the children with vitamin B12 deficiency disease using MR spectroscopy. METHODS: Eighteen children with serum vit. B12 deficiency and 12 healthy volunteer children were included in the study. All children were examined with single-voxel spectroscopy examination via 1.5-Tesla MRI. The spectra were obtained from the left frontal periventricular white matter, left lentiform nucleus and left cerebellar hemisphere. The comparisons between patient group and control group were made with ratios calculated as NAA/Cr, Cho/Cr, mI/Cr, and Glx/Cr. All brain images were also examined in terms of brain atrophy, abnormal brain parenchyma intensity changes, or myelination status. RESULTS: The children were between 3 months and 16 years old in the patient group, and between 3 months and 15 years old in the control group. There were no statistical differences in terms of metabolite ratios in the three different brain regions between the patients and control group. In two patients, periventricular white matter hyperintensities were observed. In four patients, brain atrophy was detected. DISCUSSION: MR spectroscopy examination demonstrated that there were no statistical differences in terms of all metabolite ratios in left frontal periventricular white matter, left lentiform nucleus and left cerebellar hemisphere.

The measurement of both carotid intima-media thickness and epicardial adipose tissue thickness in children with epilepsy receiving antiepileptic drug therapy.

OBJECTIVE: The aim of this study was to evaluate the carotid intima-media thickness together with the thickness of the epicardial adipose tissue in patients receiving antiepileptic drug therapy and to investigate the presence of increased cardiovascular risk in these patients. METHODS: The study included a total of 52 patients comprising 32 males and 20 females who were diagnosed as having epilepsy and who were using one or more antiepileptic drugs. The control group consisted of 34 healthy individuals comprising 16 males and 18 females. The individuals selected for the study group were requested to go to the hospital after overnight fasting. After blood sampling for serum lipid value, the carotid intima-media thickness was measured with high resolution B-mode ultrasonography and epicardial adipose tissue thickness with echocardiography in the patients and the control group subjects. RESULTS: The carotid intima-media thickness was determined as 0.47 ±â€¯0.05 mm in the patient group and 0.44 ±â€¯0.04 mm in the control group (p = 0.028). The carotid intima-media thickness was measured as 0.45 ±â€¯0.05 mm in patients with epilepsy taking monotherapy and 0.49 ±â€¯0.04 mm in those taking polytherapy (p = 0.003). The epicardial adipose tissue thickness was determined as 3.42 ±â€¯0.09 mm in the patient group and 1.72 ±â€¯0.90 mm in the control group (p = 0.000). The epicardial adipose tissue thickness was measured as 3.16 ±â€¯0.87 mm in patients with epilepsy taking monotherapy and 3.77 ±â€¯0.83 mm in those taking polytherapy (p = 0.041). CONCLUSIONS: It was determined that carotid intima-media thickness and epicardial adipose tissue thickness were significantly high in children with epilepsy taking long-term antiepileptic drugs. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. There is a need for more extensive studies on this subject.

Assessment of orbital blood flow velocities in retinopathy of prematurity.

The purpose of this study is to evaluate whether the presence of any stage retinopathy of prematurity (ROP) alters central retinal artery (CRA) and ophthalmic artery (OA) blood flow parameters in premature infants. The patients were divided into two groups according to the development of ROP; those who have ROP were defined as group I, those without ROP were defined as group II. Ninety eyes of 45 patients in group I and 40 eyes of 20 patients in group II were investigated. The blood flows in the CRA and OA were measured using ultrasound color doppler imaging (CDI) that allows to evaluate the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The results were compared between two groups of subjects. There were no significant differences in the PSV, EDV, and RI of CRA between two groups (P = 0.09, P = 0.20 and P = 0.63, respectively). The mean PSV value of OA in group I was found to be significantly higher than the one in group II (P < 0.05), but there were no significant differences in the mean EDV and RI values of OA between two groups (P = 0.40, P = 0.17 respectively). The subgroup analysis revealed that the ocular blood dynamics were not found to be significant between eyes with stage I ROP and eyes with stage II ROP (P > 0.05), whereas the difference in the mean PSV values of OA were found to be significant among the eyes with stage 1 ROP, eyes with stage 2 ROP, and eyes without ROP (P = 0.03). This study demonstrated significant alterations in systolic flow velocities in the OA predicted by CDI in infants with ROP.

Urothelial Carcinoma Concomitant With Malakoplakia In Non-Functioning Nephrolithic Kidneys.

Nephrolithic non-functioning kidney and malakoplakia are major health problems. Kidney function cannot be fulfilled and also this leads to a high risk of development of urothelial neoplasm. We report herein a case of urothelial carcinoma concomitant with malakoplakia in non-functioning nephrolithic kidneys.

Carotid artery intima-media thickness can predict the response of patients with erectile dysfunction to phosphodiesterase 5 inhibitors.

This study investigated the role of carotid artery intima-media thickness (IMT) as a morphological marker of the response of vasculogenic erectile dysfunction (ED) patients to tadalafil, one of the phosphodiesterase 5 inhibitor (PDE5-I). Through March-December 2016, 51 men with vasculogenic ED aged over 30 years were enrolled in this prospective study. Vasculogenic ED was accepted as a normal testosterone level, with penile colour Doppler ultrasonography showing arteriogenic ED, venogenic ED or mixed arteriogenic and venogenic ED. All patients underwent biochemical and hormonal blood tests, ultrasonographic evaluation of the common carotid artery (CCA) IMT and penile colour Doppler ultrasonography. On-demand tadalafil (10 mg or 20 mg in cases of a non-response to 10 mg) was administered to each patient for 2 months. ED was assessed using the short form of International Index of Erectile Function (IIEF-5) before and after the drug therapy. According to the patients' responses to the medication, they were grouped as non-responders or responders. Thirty-one of the 51 patients responded to tadalafil. The mean CCA IMT of the non-responders and responders was 0.9 ± 0.2 mm and 0.6 ± 0.2 mm, respectively (P = 0.000). The IMT of 90% of the non-responders was >0.67 mm, whereas it was >0.67 mm in 40% of the responders. The data were analysed using the Kolmogorov-Smirnov test, Chi-square test, t-test, Mann-Whitney U test and receiver operator characteristic (ROC) curves. Measurement of CCA IMT may offer an alternative and simple method to predict the response of vasculogenic ED patients to PDE5-Is.

Brain metabolite alterations in Eisenmenger syndrome: Evaluation with MR proton spectroscopy.

OBJECTIVE: Eisenmenger syndrome (ES) is a life-threatening disease characterized by pulmonary hypertension and cyanosis in patients with congenital heart diseases. The aim of this study was to determine the brain metabolite changes in Eisenmenger syndrome compared with a control group using MR proton spectroscopy. METHODS AND MATERIALS: The study included 10 children (3 male, 7 female) with congenital heart diseases and a diagnosis of Eisenmenger syndrome. The control group consisted of 10 healthy volunteer children. All were examined with a 1.5T MRI scanner and single voxel spectroscopy was performed to obtain spectra from three different regions; left frontal subcortical white matter, left lentiform nucleus and left thalamus. Peak integral values obtained from the spectra were used as quantitative data. RESULTS: The ages of the children with ES were between 5 and 16 years, and between 5 and 15 years in the control group. Periventricular white matter hyperintensities were observed in 3 patients. On MR spectroscopy study, significantly lower levels of Choline metabolite (Cho) were detected in the frontal subcortical region and thalamus regions of the patients compared with the control group. There was no statistically significant difference between the levels of other metabolites (NAA, Cr, mI and Glx). In the lentiform nucleus, although the average value of Cho in ES patients was lower than that of the control group, it was not statistically significant. CONCLUSION: Cho metabolite was determined to have an important role in brain metabolism in Eisenmenger syndrome patients. Oral Cho treatment may help to extend survival.

Spinal epidural abscess in brucellosis.

Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient's symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.