Diagnostic performance of two ultrasound techniques for the detection of cleft palate without cleft lip: axial-transverse and equal sign

OBJECTIVE

There is no study that compares the diagnostic performance of ATV and ESV techniques in detecting cleft palate. We aimed to evaluate the diagnostic accuracy of two ultrasound techniques: axial-transverse (ATV) and "equal sign" view (ESV), in detecting fetal cleft palate without cleft lip.

PATIENTS AND METHODS

This prospective study was conducted from March 2019 to January 2022 in a tertiary referral hospital. Secondary palates were assessed with ATV and ESV by two experienced fetal medicine specialists who were blinded to each other's ultrasound findings. Final diagnosis was done according to postnatal physical examination. The sensitivity and specificity of the two techniques were calculated.

RESULTS

A total of 311 pregnancies which met the study criteria were evaluated. Postnatal physical examination showed that 13 (0.4%) neonates had cleft palate only (CPO). According to final diagnosis the sensitivity, specificity, positive predictive value and negative predictive value for ATV were 100%, 98.7%, 76.4%, 100% and 100% for ESV were 76.9%, 97.8%, 58.9% and 99%, respectively.

CONCLUSIONS

ATV in 2D ultrasound provides higher sensitivity and specificity than ESV in detecting CPO.

Transinguinal laparoscopic evaluation of contralateral side during unilateral inguinal hernia repair for children

BACKGROUND

Inguinal hernia repair is a common procedure in daily pediatric surgical practice.

OBJECTIVES

The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children.

STUDY DESIGN

Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study.

RESULTS

Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve.

DISCUSSION AND CONCLUSIONS

TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.

Takayasu's arteritis as the aetiology of unresolved fever in an adult patient with cystic fibrosis

Vasculitis is an unusual complication of cystic fibrosis (CF), normally affecting patients with more severe lung disease. Typical presentation is with skin disease but other organ involvement has been reported. Systemic response to bacterial colonisation and immune complex deposition secondary to chronic airway inflammation is thought to be underlying mechanism of the disease. The authors describe a 28-year-old female Turkish patient with CF presented with fever and arthralgias. The patient was known to have chronic Pseudomonas infection; therefore, a respiratory tract infection was assumed and the patient was treated with imipenem and amikacin for 14 days. Following through investigations of fever of unknown origin, Takayasu's arteritis was identified and the patient responded well to immunosuppression with corticosteroid.

Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy

BACKGROUND

Despite being highly efficient for the relief of patient discomfort due to transrectal ultrasound (TRUS) guided prostate biopsy, periprostatic anesthesia is occasionally reported to be of limited use. We aimed to evaluate the efficacy of conscious sedation, an accepted method for lessening patient discomfort due to interventional radiological procedures and compare it with periprostatic anesthesia.

METHODS

93 candidates for biopsy were randomised to three groups: group 1 (n = 31) received intravenous midazolam, group 2 (n = 31) received periprostatic lidocaine injection, whereas group 3 (n = 31) received no anesthetic before the procedure. After the biopsy patients were asked to express discomfort by visual anologue scale (VAS).

RESULTS

The mean scores for groups 1 and 2 were significantly lower than that of group 3 (1.4 +/- 1.1 and 2.0 +/- 1.5 versus 4.7 +/- 1.6, respectively; p < 0.05 for both). For patients with VAS scores exceeding 4 (moderate to severe discomfort), a significant difference was calculated between groups 1 and 2 (3% versus 29%, p < 0.05) and between each and group 3 (3% and 29% versus 80%, respectively; p < 0.05 for each).

CONCLUSIONS

Sedation is an alternative for increasing patient comfort during TRUS-guided prostate biopsy, especially in clinical situations like patient anxiety, young age, repeat biopsies or inflammatory anal diseases.

Altitudinal neglect in a patient with occipital infarction

Visual neglect has been frequently described in a horizontal direction. Altitudinal neglect, however, has rarely been described and has been associated with bilateral lesions in the parieto-occipital or temporo-occipital region. The following case report presents a patient with marked altitudinal neglect of the inferior space which was elicited using a line bisection test. The previously healthy patient had well-defined lesions solely in the occipital cortex following an embolic infarction. The present case report underlines the possibility that bioccipital lesions themselves can be responsible for altitudinal neglect.

Hepatoprotective effects of Turkish folk remedies on experimental liver injury

Seven plants which are used in Turkish folk medicine were studied for possible hepatoprotective effects. These plants are Carduus acanthoides and C. nutans (Asteraceae), Cichorium intybus (Asteraceae), Fumaria asepalae and F. vailantii (Fumariaceae), Gentiana olivieri (Gentianaceae) and Plantago lanceolata (Plantaginaceae). Stems, bracts and receptaculum of Cynara scolymus were used as natural reference drugs. Effects of the ethanolic extracts were studied using the carbon tetrachloride-induced hepatotoxicity model in rats. The extracts of F. vailantii and G. olivieri significantly prevented the elevation of plasma and hepatic malondialdehyde formation (evidence of lipid peroxidation) as well as enzyme levels (AST and ALT) in acute liver injury, which might be ascribed to their potent hepatoprotective activity. Liver sections were also studied histopathologically to confirm the biochemical results.

[Results of fundus perimetry after resorbed premacular hemorrhages under the internal limiting membrane in 10 patients]

BACKGROUND

During their acute phase, premacular hemorrhages under the internal limiting membrane induce an absolute scotoma. It is generally suspected that extravasal blood has a toxic effect on the neuroretina. The objective of this study is to investigate whether one can indeed detect sensoric defects after resorbed hemorrhages under the internal limiting membrane.

MATERIALS AND METHODS

Our patient group consisted of 10 patients with resorbed premacular hemorrhages, which had been caused by either Vasalva-Manouver or arterial macroaneurysms. In order to avoid visual field defects due to other causes, patients with diabetes, retinal vein occlusion and glaucoma were excluded from this study. The investigation was carried out with the Scotometry Programme Vers. 2.01 of the Rodenstock Scanning Laser Ophthalmoscope. Furthermore, fundus photographs were taken.

RESULTS

Under condition of no pre-existing retinal pathologies, no scotomas could be revealed at the site of the preretinal hemorrhage after full resorption. Relative or absolute scotomas could only be found in cases of pre-existing epiretinal gliosis, pigmentepitheliumdefect, persistent subretinal hemorrhages or scars.

CONCLUSION

Since no sensoric defects of the retinal receptors could be detected, the hypothesis of the extravasal blood having a direct toxic effect on the neuroretina, could not be confirmed in this patient group.

Resolution-improved dual-beam and standard optical coherence tomography: a comparison

BACKGROUND

The purpose of the study was to demonstrate the improved axial resolution and longitudinal stability of dual-beam optical coherence tomography (OCT) in comparison to conventional OCT setups used in commercially available OCT instruments.

METHODS

The conventional OCT technique is based on an interferometric setup that is rather sensitive to axial eye motions. We have developed a special dual-beam OCT technique which eliminates the influence of axial eye motions. This is achieved by using the anterior corneal surface as the reference surface for the interferometric ranging. To improve the signal quality, the different wavefront curvatures of beams reflected at cornea and retina are matched by a diffractive optical element. To improve the axial resolution, a broadband synthesized light source with an effective bandwidth of 50 nm is used, and the group dispersion of the ocular media is compensated. Tomographic images were recorded in the fovea and the optic nerve head of healthy volunteers. For comparison purposes, approximately the same locations in the same eyes were imaged by a commercially available OCT instrument.

RESULTS

Compared to the standard OCT technique, the dual-beam OCT images show considerably improved axial resolution. Especially in tomograms recorded at the fovea, dual-beam OCT resolves microstructural details that are not visible in the standard OCT images. Furthermore, the axial stability of dual-beam OCT enables the recording of exact geometrical contours of fundus layers.

CONCLUSIONS

Dual-beam OCT is able to provide structural information on the ocular fundus that is not obtained with standard OCT. The long recording times of our instrument limit the transverse resolution to 100-150 microm at present.

99Tcm-MAA lung scintigraphy in patients with Behçet's disease: its value and correlation with clinical course and other diagnostic modalities

Behçet's disease, initially described as local vasculitis involving the oral, genital mucosa and eyes, can affect many organ systems with a varying clinical course. Pulmonary lesions associated with Behçet's disease are rare and reported to have a prevalence of 1.0-7.7%. In this prospective study, 29 patients aged 16-60 years (mean +/- s: 34 +/- 10.5) were investigated for pulmonary involvement with direct radiography, computerized tomography (CT) and intravenous digital subtraction angiography. Lung scintigraphy was also performed to determine its diagnostic value. In addition, patients had a fibreoptic bronchoscopic examination, spirometric test, carbon monoxide diffusion test and methacholine test. Of the 29 patients with Behçet's disease, 17 had pulmonary involvement. The diagnostic criteria for pulmonary vasculitis and tracheobronchial tree involvement were: (1) hilar vascular prominence or mass, new alveolar and reticulonodular infiltrates on chest X-ray; (2) aphthous lesions, bleeding ulcerations, inflamed mucosal appearance on bronchoscopy; (3) vascular thrombosis or aneurysms on CT; (4) occlusion or aneurysms of the main pulmonary arteries or its branches. The value of lung scintigraphy and its correlation with other imaging modalities were investigated to determine if a lung perfusion scan alone can be used to detect pulmonary involvement in Behçet's disease. Twenty-six patients were investigated with lung scintigraphy. Thirteen of 14 patients with lung involvement were identified. Perfusion lung scintigraphy provided true diagnostic information in 96% of our patients. In eight patients without pulmonary involvement, the lung scans were normal. Although DSA specifically demonstrates pulmonary aneurysms, it involves administration of contrast media and cannot show abnormalities distal to the third pulmonary arterial branches. Although vasculitis caused by collagen disorders is physiologically indistinguishable from pulmonary emboli, most perfusion defects resolve within 3 months, which can be used as a differential diagnostic criterion in the appropriate clinical setting. Therefore, pulmonary perfusion imaging can be used to screen patients suspected of having lung involvement, especially in the absence of thrombophlebitis. In patients with thrombophlebitis, a repeat examination at 3 months is recommended to differentiate pulmonary involvement from pulmonary embolism.

Variable platelet response to low-dose ASA and the risk of limb deterioration in patients submitted to peripheral arterial angioplasty

A group of 100 patients with intermittent claudication (70 male, 30 female), treated with I00 mg ASA per day, were followed over 18 months after elective percutaneous balloon angioplasty. Platelet function was monitored over a period of 12 months by corrected whole blood aggregometry (CWBA). Upon stimulation by arachidonic acid (AA), adenosine diphosphate (ADP) and collagen, CWBA-results were obtained by an electronic acquisition and evaluation system correcting for hematocrit and platelet count of the blood sample. All patients showed a completely inhibited platelet response to AA stimulation. Comparison of the CWBA-results with clinical parameters revealed that reocclusions at the site of angioplasty occurred exclusively in male patients for which CWBA failed to prove an inhibition of aggregation upon both agonists, ADP and collagen, and for these patients the risk of complication is at least 87% higher (p = 0.0093). Only 40% of male patients show the expected effect of ASA on in vitro platelet aggregation at any given point in time and CWBA is capable of predicting those male patients which are at an elevated risk of reocclusion following peripheral angioplasty.

Effects of Cistus laurifolius L. flowers on gastric and duodenal lesions

The flowers and flower buds of Cistus laurifolius L. are used for the treatment of peptic ulcers. Through the bioassay-guided fractionation of the material, using water immersion and immobilisation-induced stress ulcer model, the EtOH-precipitated part from the aqueous extract (E-H2O decreases) was determined to be the active fraction. For the evaluation of the mode of action, the activity of E-H2O decreases was tested using various ulcer models in rats and mice and this fraction was found active against pylorus ligation-, abs. ethanol-, indomethacin-, indomethacin plus HCl/EtOH-induced gastric and cysteamine-induced duodenal lesions while ineffective against serotonin-induced gastric lesions. The active fraction showed its activity not only on per os administration but also after subcutanous injection. According to the results of biochemical studies, the active fraction showed a potent antiacid activity. In addition, histopathological, and toxicological studies were conducted with the active fraction.

The mydriatic effect of tropicamide and its diagnostic use in Alzheimer's disease

The mydriatic effect of topically administered tropicamide was investigated as a possible diagnostic indicator for Alzheimer's disease. Although an initial series seemed to show a correlation between hypersensitivity to tropicamide and intellectual impairment, subsequent testing showed a greater inter- and intra-individual variation than that between the normal group and the group of patients with intellectual impairment. This procedure seems, therefore, to lack sufficient specificity to be useful for such a diagnostic purpose.

The efficient use of perimetry for neuro-ophthalmic diagnosis

AIMS/BACKGROUND

Automated perimetry is both one of the most important diagnostic procedures in ophthalmology and the most difficult for the patient who is required to comply with strict and tiring conditions. This paper examines the use of a moving fixation target and a strategy for full threshold determination only in those data points found to be abnormal.

METHODS

142 eyes in 71 patients were subjected to two types of visual field tests: the Dicon TKS 4000 Autoperimeter program 5 and the Humphrey field analyser program 30/2. The first procedure was compared with a commonly used instrument and strategy that is usually employed for the management of glaucoma patients.

RESULTS

Such a strategy was used in patients presenting with neuro-ophthalmic problems taking an average testing time of 14.9 minutes. The alternative test described here took an average of 3.9 minutes, without loss of diagnostic value.

CONCLUSION

The shorter testing time results in greater patient acceptance, fewer fatigue induced artefacts, and the possibility of completing a perimetry test with patients whose ability might seriously be challenged by a longer test. The reduced time required and the more natural condition of not having to fixate on an unmoving position were found not to reduce the diagnostic value of the data produced in patients presenting for various reasons at a neuro-ophthalmology clinic.

Influence of hematocrit and platelet count on impedance and reactivity of whole blood for electrical aggregometry

Previous studies have shown that differing qualities of blood specimen seem to influence whole blood electrical aggregometry (WBEA), making it difficult to standardize the method. The aim of this study was to investigate the impact of hematocrit (HCT) and platelet count (PLC) on in vitro platelet aggregation in citrated whole blood (CWB) in order to compensate for their possible effects on impedance aggregometry. Red blood cells and blood platelets were isolated from fresh citrated whole blood taken from 15 healthy donors (mean age = 26 years) and recombined to 20 physiologically relevant combinations of hematocrit and platelet count (HCT: 20-50, PLC: 100-500). Platelet aggregability was measured using WBEA with three different triggers. A special-purpose software package was used in this study, ensuring proper calibration, acquisition, and evaluation of analogue to digital converted data, allowing the calculation of a set of characteristic parameters of each impedance curve. Most of the linear regressions showed that all parameters significantly depend on HCT and PLC. Furthermore, we found interactions of both variables, making it impossible to focus on the effects of one of the investigated variables only. The outcome of this study is a set of dependences, allowing the calculation of regressions for in vitro aggregation in whole blood, enabling a comparison of blood of any quality with each other, regardless of the variables HCT and PLC. Together with the previously defined dependence of sample age on WBEA data, this step should help to make this technique a more reliable and practicable clinical tool, making it suitable for daily routine investigations.

Platelet function after total artificial heart replacement: clinical application and experiment

Clinical application of artificial blood pumps for mechanical circulatory support has been hampered by thromboembolic events. The underlying mechanisms are complicated and may differ from patient to patient. Because the calf is commonly used for artificial heart studies, the object was to determine the value of data gained in an animal model. To this end, the average of 10 calf experiments was compared with three clinical applications of an orthotopically implanted total artificial heart in patients with terminal heart failure. Platelet reactivity was investigated in vitro by collagen-induced whole blood aggregometry, radioimmunoassay methods, and scanning electron microscopy over a 10-day period. An analogous periodicity of platelet function was found in human and animal recipients. Improvement of platelet function preceded that of platelet counts in the early postoperative phase. Exaggerated responses to aggregative agents were observed at days 3 and 7. On the basis of our data, we believe that we can comment about the prospective course of the function and number of human platelets, which may contribute to the identification of critical phases of such treatment, during total artificial heart replacement.

Odontogenic tumours. A series of 409 cases

Reports on the incidence of odontogenic tumours are infrequent with only a limited number of series having appeared in the literature. In this paper, the results of a multicentre retrospective study on the histologic types and relative frequencies of odontogenic tumours in Turkey are presented. The results indicated that the most frequent histologic type was ameloblastoma (36.5 per cent) and the area at greatest risk for the development of odontogenic tumours was the mandibular molar region. A Table showing the most likely type of tumour by location is also presented.