Coeliac trunk and common hepatic artery variations in children: an analysis with computed tomography angiography

BACKGROUND

Understanding the coeliac trunk (CeT) and hepatic artery anatomy is important not only in preventing iatrogenic injuries but also in planning surgical procedures in children. Therefore, the aim of this study is to analyse the prevalence of CeT and common hepatic artery (CHA) variations in the paediatric population.

MATERIALS AND METHODS

One hundred and seventy-four children who underwent abdominal multidetector computed tomography (MDCT) angiography, either because of trauma or liver transplantation, were analysed retrospectively. The patterns of CeT, CHA and their variant branches were revealed and compared with previous studies involving adults.

RESULTS

A total of 157 (90.2%) of the 174 patients had normal CeT anatomy, whereas 17 (9.8%) had variations. Five types of CeT variations were identified according to Song's classification in which 'hepatosplenic trunk + left gastric artery + superior mesenteric artery' was the most prevalent. One hundred-twelve (64.4%) of the 174 patients had normal CHA anatomy; however, 62 (35.6%) had variations. Six types of CHA variations were identified according to Michel's and Hiatt's classification. The most common was 'replaced left hepatic artery originating from left gastric artery'.

CONCLUSIONS

The prevalences of CeT and hepatic artery variations are high in children, as they are in older patients. Awareness of these variations is important in terms of avoiding iatrogenic injury and in promoting surgical procedure planning for liver transplantation or abdominal tumour surgery.

Synthesis, characterization and antibacterial activity of juglone encapsulated PLGA nanoparticles

AIMS

The aim of the study was to examine the effect of different process parameters which including; initial juglone amount, initial poly(d,l-lactide co-glycolide) amount, polyvinyl alcohol volume and polyvinyl alcohol concentration on encapsulation of juglone to poly(d,l-lactide co-glycolide) nanoparticles.

METHODS AND RESULTS

The synthesized nanoparticle formulations were analyzed for reaction yield, encapsulation efficiency, particle size, polydispersity, zeta potential and juglone release. In conjunction with the highest encapsulation rate, the highest amount of juglone release was obtained for F4 formulation, which has 281·8 nm particle size, 0·217 polydispersity index, and -19·55 mV zeta potential. After the detailed physicochemical characterization of this formulation, the four different kinetic models were used and it was found that juglone release mechanism controlled by Fickian diffusion method. According to antimicrobial activity results, minimal inhibitory concentration (MIC) values of both F4 and free juglone is higher for Gram negative bacteria than Gram positive bacteria. Inhibition zone diameters in the quantitative methods are found 15 and 16 mm for Staphylococcus aureus, 9 and 7 mm for Bacillus cereus, respectively, for F4 and free juglone. Moreover, the MIC values for qualitative methods were found 31·5 μg ml^-1 for two bacteria strains.

CONCLUSIONS

It was found that the antibacterial activity of the juglone nanoparticles was higher and longer than the free juglone. Additionally, a similar antimicrobial effect with a lower juglone amount (obtained from controlled release study) indicates that nanoparticle formulation is more effective.

SIGNIFICANCE AND IMPACT OF THE STUDY

The use of nanoparticle formulations of juglone in biological systems and applications could be more beneficial than its free form due to its toxicity.

Methyl palmitate attenuates lipopolysaccharide-induced acute lung injury in mice

AIM

The study is aimed to determine the beneficial effects of methyl palmitate (MP) which has antioxidant and anti-inflammatory effects demonstrated on murine model of acute lung injury induced by lipopolysaccharide (LPS).

MATERIALS AND METHODS

Forty male BALB/C mice were randomly allocated into four groups (n=10, each): control group, methyl palmitate group (300 mg/kg), LPS group, and methyl palmitate -treated groups. Methyl palmitate or vehicle was given with an intraperitoneal administration 1 h before an intratracheal instillation of LPS (5 mg/kg). The severity of pulmonary injury was evaluated 6 h after LPS challenge. All experimental procedures complied with the requirements of the Animal Care and Ethics Committee of the Adnan Menderes University.

RESULTS

Methyl palmitate pretreatment significantly attenuated LPS-induced pulmonary histopathologic changes, alveolar hemorrhage, and neutrophil infiltration. Methyl palmitate pretreatment also reduced the concentrations of malondialdehyde in lung tissues.

CONCLUSIONS

This study indicates that methyl palmitate may have a protective effect against LPS-induced acute lung injury, and the potential mechanism of this action may involve the inhibition of NF-κB. activation.

THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO

The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.

Idiopathic Lumbar Epidural Lipomatosis Mimicking Disc Herniation: A Case Report

Spinal epidural lipomatosis is a rare condition which is described as the accumulation of fat in the extradural territory and often causes dural impingement. Spinal epidural lipomatosis has been implicated in causing a variety of neurologic impairments ranging from back pain, radiculopathy, claudication, myelopathy or even cauda equina syndrome. We report a 46-year-old female with obesity and a history of chronic back pain and radiculopathy who developed idiopathic Spinal epidural lipomatosis diagnosed by magnetic resonance imaging. The purpose of this report is to present a case of spinal epidural lipomatosis presenting with symptomatic cord compression and also remind this rare condition as a the differential diagnosis of epidural lesions in patients with risk factors.

Corticosteroid Responsive Sarcoidosis with Multisystemic Involvement Years after Initial Diagnosis: A Lymphoma Mimicker on 18-FDG PET/CT

Sarcoidosis is a chronic multisystemic inflammatory disease characterized by noncaseating epithelioid cell granulomas. 18-Fluorodeoxyglucose positron-emission tomography/computer tomography (FDG-PET/CT) is increasingly used in routine clinical practice to assess active sarcoidosis because it can detect active inflammatory granulomatous disease. However, active sarcoidosis lesions are observed to be hypermetabolic on FDG-PET/CT much like malignancies, which may lead to misinterpretation on imaging. In this case report, we present a rare case of sarcoidosis with multisystem involvement including lung, lymph nodes, bone, pleura, and soft tissue that mimicked lymphoma on FDG-PET/CT and responded to corticosteroid treatment.

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign

AIMS

To review the detailed gray-scale and Doppler ultrasonography features of histologically proven parathyroid adenomas (PAs) evaluated with high-end ultrasonography devices and to present a novel ultrasonography finding called the dual concentric echo sign in PA with histopathologic correlation which was encountered during detailed analysis.

MATERIAL AND METHODS

Fifty-six PAs with histopathological result were enrolled. The longest dimension, shape, distance to skin surface, internal echo and Doppler US features obtained with high-end US devices were evaluated.

RESULTS

PAs had variable range of shape including oval, irregular, fusiform, lobulated, crescent-shaped, and nodular configuration. In nine patients the lesions were shown to have cystic components and calcifications were seen in four cases. Dual concentric echo sign was detected in 18% PAs. Histological reevaluation of this subgroup demonstrated significantly increased edema (p<0.01), and ectatic vessels (p=0.02) in the central part of the lesion compared to the rest of the PAs.

CONCLUSIONS

The results of the study led to the conclusion that PAs have variable gray-scale and Doppler findings. Typical sonographic features like ovoid shape, homogeneously hypoechoic pattern may not be present in all PAs. Dual concentric echo sign which is a novel sonographic pattern may be suggestive of a PA.

Cross-sectional Imaging Features of Primary Retroperitoneal Tumors and Their Subsequent Treatment

Basically malignant tumors in the retroperitoneal region arise from a heterogeneous group of tissues: mesodermal, neurogenic, germ cell, and lymphoid. Although rare, benign tumors and cystic masses can be also encountered in retroperitoneal space. Developments in computed tomography (CT) and magnetic resonance imaging (MRI) have contributed to both diagnosis and staging of the retroperitoneal tumors. High spatial resolution and superiority in calcification make CT indispensable; on the other hand, MRI has a better soft-tissue contrast resolution which is essential for the assessment of vascular invasion and tissue characterization. The aim of this article is to review the CT and MRI features of retroperitoneal tumors and their subsequent management.

Imaging findings of pulmonary granulomatosis with polyangiitis (Wegener's granulomatosis): lesions invading the pulmonary fissure, pleura or diaphragm mimicking malignancy

BACKGROUND

Granulomatosis with polyangiitis (GPA, formerly Wegener's granulomatosis), in which pulmonary involvement often predominates, is a multisystem granulomatous, necrotizing vasculitis that affects small and medium-sized vessels. In this study we evaluated various radiological findings of pulmonary GPA and focused on spiculated pulmonary lesions invading the pulmonary fissure, pleura or diaphragm mimicking malignancy.

METHODS

This retrospective study included 48 patients, aged 28-73 (mean, 47.3) years, who showed either histopathological diagnosis of GPA (n = 39) or elevated levels of the cytoplasmic anti-neutrophilic cytoplasmic antibody serum marker (n = 9) between January 2003 and December 2013. All patients received a chest computed tomography (CT), and the types of pulmonary lesions were defined and evaluated.

RESULTS

Among the 48 patients, 33 had abnormal pulmonary findings on CT. The most commonly detected pulmonary lesion types were nodules and masses (n = 126) observed in 24 patients. Cavitation, necrosis, spiculation and invasion of the fissure, pleura or diaphragm were observed in 14, 9, 10 and 6 patients, respectively. Consolidation was found in 14 patients and thickening of bronchial wall in 8 patients.

CONCLUSIONS

Pulmonary lesion types of GPA have a wide spectrum, potentially mimicking a high number of diseases including malignancy, infection and noninfectious inflammatory diseases. A spiculated lung lesion invading the fissure, pleura or diaphragm is mostly present in malignancy, but it can be also seen in GPA.

Ganglion cysts in the lateral portal region of the knee after arthroscopy: report of two cases

A ganglion cyst (GC) is a mucinous or gelatinous-filled benign tumor overlying a joint or tendon sheath, which commonly arises in the dorsal and volar wrist side but may occur anywhere in the body. Although cystic lesions around the knee are common, the occurrence of GCs are rare. Ganglia may arise from intra or extra-articular, soft tissue, intraosseous, or periosteal location. Symptoms may vary according to the size and location. After the more frequent performance of magnetic resonance imaging for the assessment of a knee joint, the number of incidental, asymptomatic lesions have been increasingly diagnosed. The etiology of GC remains unclear; however, trauma and a flaw in the joint tissues may explain its appearance. The authors report two cases of women aged 47 years and 37 years who presented pain and swelling in their left knees following arthroscopic partial medial meniscectomy. The former was surgically treated and had a favorable outcome, while the latter had conservative treatment and a gloomy outcome.

Supraclavicular lymphadenopathy: should it be perceived as the virchow's node of head and neck tumors?

BACKGROUND

In this study, we aimed to determine the correlation between supraclavicular lymph node involvement (SLNI) and metastatic potential, frequency, and metastases predilection sites in patients diagnosed with various head and neck tumors (HNT) and staged via positron emission tomography/computed tomography (PET/CT) imaging. We also investigated the impact of different variables on SLNI.

PATIENTS AND METHODS

270 patients diagnosed with HNT were enrolled in the study (194 males and 96 females, mean age 54.9 ± 14.7 years (range 18-89 years)).

RESULTS

Nasopharyngeal carcinoma demonstrated significant SLNI (p < 0.01); however, other subtypes of HNT did not. In all HNT studied, no apparent metastatic predilection tendency for the supraclavicular region was observed, as opposed to the well-described Virchow's node. Age, gender, tumor size, and systemic metastases were not identified as statistically significant variables contributing to SLNI. Multivariate regression analysis revealed an increased cervical (p < 0.01) and thoracic (p = 0.001) lymph node involvement in patients with SLNI.

CONCLUSION

SLNI with the possibility of metastasis was more frequently observed in nasopharyngeal carcinoma, advancing the nodal status without significantly influencing the T and M stages. A careful evaluation of this very small region is of critical importance for proper nodal staging in nasopharyngeal cancer patients.

Volumetric evaluation of fat in the renal sinus in normal subjects using stereological method on computed tomography images and its relationship with body composition

BACKGROUND

The aim of the study was: to describe a simple, accurate and practical technique for estimating the volume of adipose tissue within the renal sinus (RS) using stereological method on computed tomography (CT) images; to establish a population database for volume of fat within the RS from 21 to 80 years of age; to investigate the effect of age, gender, body mass index (BMI) and abdominal diameters on RS fat volume in normal subjects.

MATERIALS AND METHODS

We retrospectively reviewed abdominal CT examinations of 240 patients without renal pathology between the ages of 21 and 80 years. There were 6 groups of patients, with 40 patients for each decade.

RESULTS

RS fat volumes in the left and right kidney were 5.70 ± 2.87 cm³ and 4.15 ± 2.39 cm³, respectively, in males and 3.51 ± 2.67 cm³ and 2.49 ± 2.16 cm³, respectively, in females. RS fat volume and age were positively correlated for both kidneys (left: r = 0.46; right: r = 0.44; p < 0.001, both), though it appeared to decline after age 70.

CONCLUSIONS

Quantitative data may allow clinicians to better estimate the age-related RS fat volume changes and help them in decision making.

Effectiveness of thymoquinone in the treatment of experimental asthma

BACKGROUND

Thymoquinone (TQ), the main active constituent of the volatile oil extracted from Nigella sativa's seeds, is used for the treatment of inflammatory diseases and exhibits a variety of pharmacological effects.

METHODS

Twenty-eight BALB/c female mice were divided into four groups: I (sham-operated control group), II, III, and IV. All groups except for the sham-operated group were sensitized and challenged with ovalbumin. The sham-operated group received nebulized saline in challenge period. Mice in groups III and IV were administered TQ at a dose of 3 mg/kg and dexamethasone 1 mg/kg, respectively, intraperitoneally once a day for the final 5 days of the challenge period. Animals were sacrificed 24 h after the last drug administration and the airway samples were evaluated histologically by light microscopy.

RESULTS

All histological parameters in Group III, similar to Group IV, were improved when compared to Group II. All variables except numbers of goblet cells were found to be significantly better in Group III and Group IV compared to Group II.

CONCLUSIONS

In our study, we demonstrated that TQ administration alleviates the pathological changes of chronic asthma. TQ might be a promising therapy for asthma in the.