Development of primary central nervous system lymphoma in a systemic lupus erythematosus patient after treatment with mycophenolate mofetil and review of the literature

Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma and four cases of PCNSL have previously been described in association with mycophenolate mofetil. We report the fifth case of PCNSL in a patient with lupus nephropathy while on mycophenolate mofetil treatment.

The Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Parameters in Head-Neck Tumors

We evaluated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in various head-neck masses, some of which are very rare tumors whose DCE-MRI have not been published to date. The purpose of this study was to investigate DCE-MRI in the differentiation of benign versus malignant lesions and to evaluate the DCE-MRI parameters most predictive for malignancy. Forty-one head-neck tumors including parotid gland tumors in 41 patients were examined at gadolinium-enhanced dynamic MR imaging. There were 26 malignant and 15 benign tumors. DCE-MR images were obtained between four and six minutes. Time-signal intensity curves (TICs) of the tumors on dynamic MR images were plotted, and then time of peak enhancement ( Tpeak), and enhancement ratios (ER) with different times (such as ER30, ER60, ER90, ER120, ERmax) were also calculated. Data of the benign and malignant group with head-neck masses were compared by Mann-Whitney U-test. The mean values of time to peak ( Tpeak) were found to be significantly shorter for the malignant group than the benign tumors ( P<0.05). The mean enhancement rates of malignant lesions were ER30: 60.62±52.62, ER60: 105.65±56.26, ER90: 113.17±45.83, ER120: 116.59±46.75 and ERmax: 128.56±56.51 whereas the mean enhancement rate of benign lesions were ER30: 67.35±60.78, ER60: 79.79±63.33, ER90: 84.53±64.92, ER120: 88.41±67.07 and ERmax: 112.06±66.48. The mean signal intensity values of the 60th second (ER60) and 90th second (ER90) were significantly different from other values for predicting malignancy ( P<.05). The parameters obtained from the time-signal intensity curve are important in differentiating benign and malignant enhancing lesions in dynamic head-neck MR imaging. DCE-MRI cannot replace standard MR imaging sequences for evaluating head-neck masses, but in addition to routine MR imaging it will improve differentiation between benign and malignant lesions.

Vertebrobasilar insufficiency and gamma-glutamyltransferase: An emerging relationship demonstrating inflammation and atherosclerosis

OBJECTIVES

Vertebrobasilar insufficiency (VBI) is a pathology arising from the reduction in flow rate of vertebral arteries and mainly caused by inflammation and atherosclerosis. Gamma-glutamyltransferase (GGT) is a marker which has been recently recognized as a marker of inflammation and atherosclerosis. We aimed to investigate the relationship between GGT levels and VBI for the first time.

METHODS

In this cross-sectional study, of 3100 subjects who had vertebrobasilar doppler ultrasonography (VBU) were evaluated and 1042 of them who met the inclusion criterias were included. VBU reports, GGT levels, blood chemistry, lipid profile were received from patients' files. Patients were evaluated according to VBU measurements and divided into two groups,VBI and non-VBI.

RESULTS

Mean vertebral arterial blood flow volume values were 149.99±32.93 mL/m in VBI group and 286.88 ± 70.98 mL/m in non-VBI group. Mean GGT and CRP values were significantly higher in the VBI group than in the non-VBY group (p < 0.001) ( p < 0.001), respectively. Vertebral artery blood flow volume was negatively correlated with GGT (r: -0.208, p < 0.001) and CRP (r: -0.119, p < 0.001).

CONCLUSION

We demonstrated a significant correlation between serum GGT levels and VBI. In addition, higher GGT level was an independent risk factor for the presence of vertebrobasilar system inflammation and atherosclerosis (Tab. 2, Fig. 3, Ref. 27).

Antioxidant and renoprotective effects of sphingosylphosphorylcholine on contrast-induced nephropathy in rats

Contrast induced nephropathy (CIN) is a major cause of morbidity, and increased costs as well as an increased risk of death. This study was evaluated effects of exogenous sphingosylphosphorylcholine (SPC) administration on CIN in rats. Eight animals were included in each of the following eight groups: control, control phosphate-buffered solution (PBS), control SPC 2, control SPC 10, CIN, CIN PBS, CIN SPC 2 and CIN SPC 10. The induced nephropathy was created by injected with 4 g iodine/kg body weight. SPC was administered 3 d at a daily two different doses of 2 μm/mL and 10 μm/mL intraperitoneally. The severity of renal injury score was determined by the histological and immunohistochemical changes in the kidney. Malondialdehyde (MDA), nitric oxide (NO) and superoxide dismutase (SOD) were determined to evaluate the oxidative status in the renal tissue. Treatment with 2 and 10 μM SPC inhibited the increase in renal MDA, NO levels significantly and also attenuated the depletion of SOD in the renal injuryCIN. These data were supported by histopathological findings. The inducible nitric oxide synthase positive cells and apoptotic cells in the renal tissue were observed to be reduced with the 2 and 10 μM SPC treatment. These findings suggested that 2 and 10 μM doses can attenuate renal damage in contrast nephropathy by prevention of oxidative stress and apoptosis. The low and high dose SPC may be a promising new therapeutic agent for CIN.

Ultrasonographic Tinel Sign: two case reports

Peripheral nerve sonography has been regarded as an important tool for evaluating anatomic changes within nerves and muscles. Over the last few years, the role of ultrasonographic Tinel (UST) in diagnostic sensitivity and its relationship to neurophysiologic findings has increased. Ultrasonographic Tinel sign helps to interpret the ultrasonographic and clinical findings and have proven useful in making a diagnosis.

Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymptomatic nerve thickness

There is still no consensus on a normal value for the cross-sectional area of the ulnar nerve at the elbow. Such data would be valuable for the ultrasound diagnosis of ulnar neuropathy. Comparison of the symptomatic and contralateral asymptomatic sides has been recommended. The aim of this study was to investigate whether or not the asymptomatic ulnar nerve could be a reference value. High-resolution ultrasonic measurements of the cross-sectional areas of the ulnar nerves at the elbow were compared with 38 contralateral asymptomatic elbows of patients with unilateral ulnar neuropathy and 38 healthy controls. There were significant differences in the cross-sectional areas at all levels between the healthy control subjects and asymptomatic side of the ulnar neuropathy patients (p < 0.05). The findings of this study suggest that there is a limitation in using the asymptomatic side for obtaining reference values in ultrasonographic studies. Each ultrasonographic laboratory should determine its own reference values.

Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study

PURPOSE

To investigate if maternal serum pregnancy-associated plasma protein-A levels are affected in hyperemesis gravidarum (HG).

MATERIALS AND METHODS

A prospective case control study was conducted in 169 HG cases who had one or more antepartum hospitilization for HG. The control pregnancies were 132 and were selected randomly among all women who had first trimester prenatal screening in antenatal outpatient clinic between 2011 and 2012.

RESULTS

Maternal serum pregnancy-associated plasma protein-A levels were significantly higher in hyperemesis gravidarum group compared with control group (p = 0.002 p < 0.05 95% CI). Power analysis of independent sample t-test, two-sided, for pregnancy-associated plasma protein-A was 0.88. Maternal serum free beta-human chorionic gonadotropin values were not different between two groups (p > 0.05).

CONCLUSION

Increased pregnancy-associated plasma protein-A levels associated with HG, even after excluding potential cofounders.

Frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women

AIM

Assessment of previous vertebral fractures provides useful information to predict future fracture risk. This study aimed to determine the frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women.

MATERIAL AND METHODS

Data on patient characteristics, bone densitometry values, and spine radiographs (T2-L5) were reviewed in 232 postmenopausal women admitted to our osteoporosis clinic.

RESULTS

Prevalent vertebral fractures were detected in 28 (12.1%) women (95%CI: 7.8 16.3). Fifteen women (6.5%) had mild fractures and 13 (5.6%) had moderate or severe fractures according to Genant's semi-quantitative technique. The T-score was associated with the presence of prevalent vertebral fractures (OR= 0.61; 95%CI: 0.38-0.96, P= 0.034). The most frequently fractured vertebrae were T11 and T12, followed by T7 and T9. Sixty percent of fractures were wedge-type while 40% were biconcave. The frequency of wedge-type fractures at the T11-T12 levels (93.8%) was higher compared to that at all other levels (44.1%) (P= 0.001).

CONCLUSION

We determined the frequency, distribution, and severity of prevalent fractures and identified certain distribution patterns of fracture locations and types. To verify our results and detect possible predictive factors for fracture risk, population-based larger trials are needed.

Bilateral extra-adrenal perirenal myelolipomas: CT features

Myelolipomas are rare benign tumours composed of adipose tissue and haematopoietic cells that are typically found in adrenal glands but have also appeared in extra-adrenal sites. Distinguishing between extra-adrenal myelolipomas and malignant tumours, such as liposarcomas, is crucial to avoid an invasive procedure. To this end, we present a comprehensive report of the CT imaging characteristics of a pathologically proven bilateral extra-adrenal perirenal myelolipoma.

Hemobilia and occult cystic artery stump bleeding after a laparoscopic cholecystectomy: endovascular treatment with N-butyl cyanoacrylate

Hemobilia is a rare phenomenon. In this case report we present an emergent transcatheter glue embolization (in which N-butyl cyanoacrylate is used as an embolizing agent) due to arteriobilary fistula occurred following the laparoscopic cholecystectomy in a 41-year-old woman.

Incidental pancreatic lipomas: computed tomography imaging findings with emphasis on diagnostic challenges

PURPOSE

The purpose of this study was to describe the computed tomography (CT) findings of pancreatic lipomas of 9 cases, with emphasis to diagnostic challenges.

METHODS

Between March 2006 and April 2008, 9 patients with pancreatic lipomas that were diagnosed by CT were reviewed in the present study. Clinical data and CT features of these 9 cases were retrospectively analysed. The patient population included 5 men and 4 women, aged 42-81 years (mean age, 65.8 years). The patients were followed up for at least 2 years with control CTs.

RESULTS

In all 9 cases, a well-bordered nodular fat density lesion was incidentally detected in the pancreas. Four of the lesions had a lobulated contour, and 2 of them had septations. Two of the lipomas were located in the head, 3 in the neck, 3 in the corpus, and 1 in the tail. The CT densitometric values were between -90 and -120 HU, with a mean value of -106 HU. No pancreatic or biliary dilatation or compression to the adjacent structures was seen. All the cases had control CTs, and the lipomas remained unchanged during the follow-up period. Histopathologic confirmation of the diagnosis was not planned for the cases.

CONCLUSION

Lipomas are rarely encountered in the pancreas. They often are diagnosed coincidentally as small, well-circumscribed, encapsulated, homogeneous, mature adipose masses on imaging studies. Imaging follow-up strategy or histopathologic confirmation is not necessary in asymptomatic patients.

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity

BACKGROUND

In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity.

METHODS

The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention.

RESULTS

The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%.

CONCLUSION

ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.

Segmental costovertebral anomaly presenting with horn-like appearance in the chest

Several types of abnormalities of the ribs have been reported. Many of these anomalies usually result in the correct diagnosis thanks to the characteristic radiological appearances. But some of the anomalies are rare and it is important to recognize and get accustomed to differing appearances of these osseous abnormalities in order to differentiate the pathological processes and to diagnose the syndromes which may accompany rib anomalies. The localized costovertebral anomaly with horn-like appearance, which has not yet been described in literature, is presented in this paper.

Cypermethrin-induced histopathological and biochemical changes in Nile tilapia (Oreochromis niloticus), and the protective and recuperative effect of ascorbic acid

The objective of this study was to investigate the effects of ascorbic acid on the toxicity of cypermethrin's on histopathological lesions in tissues and protein, glycogen levels in Oreochromis niloticus. Nile tilapia was exposed to 0.22 and 0.44 μg/l cypermethrin+control diet, 0.22 and 0.44 μg/l cypermethrin+ascorbic acid supplemented diet for 20 days. The fish were allowed recuperation period of 15 days in pesticide-free water and fed with ascorbic acid suplementation diet. In light microscopic investigation, histopathological lesions were observed in the gill, liver and kidney. The severity of lesions accreted depending on increased pesticide concentration and control diet. Some of the lesions were reversible or at least were less pronounced after recuperation period. Protein levels decreased in some groups after treatment period according to control groups (p<0.05). The highest depletions in liver, muscle and gill protein levels were found in 0.44 μg/l cypermethrin+ascorbic acid supplemented diet group (62.23%), in 0.22 μg/l cypermethrin+control diet group (53.12%) and in 0.44 μg/l cypermethrin+control diet group (61.87%) after 10 days, respectively. These levels increased at the end of the recuperation period. The highest depletion in liver glycogen levels was found in 0.22 μg/l cypermethrin+control diet group (50.50%) after 10 days (p<0.05). At the end of recuperation period, there was no difference between the groups (except 0.22 μg/l cypermethrin+ascorbic acid supplemented diet group) and controls. The decrease of muscle glycogen, except 0.22 μg/l cypermethrin+ascorbic acid supplemented diet group, was recorded at the end of 10 and 20 days. In the recuperation period, an increase was observed at all groups. These results revealed that the histopathology, protein and glycogen can work as good indicators of stress of a toxicant on fish. Ascorbic acid serves fish as an antitoxic agent against pesticide toxicity.

Evaluation of the effect of local corticosteroid injection and anti-inflammatory medication in carpal tunnel syndrome

BACKGROUND AND AIMS

To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study.

METHODS

A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), (JTT) Jebsen Taylor Test and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints.

RESULTS

The mean age of the patients was 40.8 +/- 11.2 (range 21-64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, 'writing', 'picking up small common objects' and 'picking up large heavy objects' activities were improved in group A; 'writing' and 'stacking checkers' activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A.

CONCLUSIONS

The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.

Phase inversion harmonic imaging improves assessment of renal calculi: a comparison with fundamental gray-scale sonography

PURPOSE

To compare phase inversion harmonic imaging (PIHI) with fundamental imaging (FI) in the evaluation of renal calculi.

METHODS

Thirty adult patients with renal calculi (17 men, 13 women; mean age 44 years [range, 25-71]) underwent transabdominal sonographic examination of the urinary system. Both kidneys and renal calculi were examined with PIHI and FI. Overall renal conspicuity, calculus visibility, and clarity of posterior shadowing were assessed subjectively using a 4-point scale (0 being the worst, 3 being the best). The maximum diameter of the calculi was measured using both techniques. The effect of body mass index on qualitative scoring and quantitative measurements was evaluated.

RESULTS

PIHI improved overall renal conspicuity compared with FI (p < 0.001). The visibility of the calculi and clarity of posterior shadowing were significantly better with PIHI than with FI (p < 0.001 for both parameters). The maximum diameter of calculi was larger with PIHI than with FI (p < 0.001). The superiority of PIHI over FI regarding overall conspicuity of the kidney, visibility of the calculus, and clarity of posterior shadowing scores increased in the obese group (p < 0.001 for all 3 parameters). The mean calculus diameter difference between the 2 techniques was significantly higher in the obese group.

CONCLUSION

The routine use of PIHI is recommended in the evaluation of renal calculi.

The effects of medical treatment and rehabilitation in a patient with adult tethered cord syndrome in the late postoperative period

BACKGROUND

The possibility of functional tethered cord syndrome (TCS) should be considered when adolescent patients present with unexplained lumbar, buttock, and leg symptoms. Symptoms progress if untreated. Success depends on early diagnosis, the complete untethering of the spinal cord, and rehabilitation. A rare case of adult TCS is reported.

CASE REPORT

A 42-year-old female patient with lower back and leg pain, severe flexor reflex responses, and a walking disorder was evaluated. Gabapentin and tizanidine were given to treat the neuropathic pain and flexor reflex responses. An exercise program was applied to improve the walking disorder. Finally, the patient's complaints of pain considerably decreased, flexor reflex responses were reduced, and a more comfortable walking motion was observed.

CONCLUSIONS

A rehabilitative approach is very important and a multidisciplinary follow-up and treatment procedure is required in the clinical healing process of all patients presenting with a tethered cord condition, whether surgical intervention is carried out or not.

An unusual metastatic site of tongue carcinoma: shoulder muscles

The incidence of skeletal muscle metastases is reported to be less than 1% of metastases of haematogenous origin. Distant skeletal muscle metastases from head and neck squamous cell carcinomas are exceedingly rare. Only a case with tongue carcinoma metastasized to paravertebral muscles, has been reported so far. The reasons for the rarity of metastatic involvement of skeletal muscle are still unclear. The presence of skeletal muscle metastases in the setting of disseminated disease offers no hope for curative treatment. We report an unusual case of a 63-year-old patient with tongue carcinoma metastasizing to the left shoulder muscles. To our knowledge, this is the first such case to be reported in the English medical literature.

The relation of hand functions with radiological damage and disease activity in rheumatoid arthritis

The purpose of this study was to investigate specifically the correlation of hand functions determined by Duruoz hand index (DHI) with radiological findings and disease activity in rheumatoid arthritis (RA) patients. Forty-eight RA patients were evaluated with DHI questionnaire, disease activity score (DAS) 28 and modified Larsen scoring method. Correlation between DAS-28 and DHI was assessed in all the patients. Mean DHI scores were compared between patients in remission (DAS-28 < 2.6) and patients who have more or less disease activity (DAS-28 >or= 2.6). To exclude the probable conflicting effect of disease activity on hand functions, the correlation between radiological scores and DHI was investigated only in patients with remission. There was a positive correlation between DAS-28 and DHI in all patients group (r = 0.434, P < 0.002). No correlation between the radiological scores of any joint groups and DHI could be found in patients with remission. Hand functions seemed to be affected prominently from disease activity. Radiological scores demonstrating joint damage were not in relation with hand functions.

Primary serous papillary carcinoma of the retroperitoneum: magnetic resonance imaging findings with pathologic correlation

The incidence of a primary serous papillary carcinoma of the retroperitoneum is extremely rare. We present a case of the tumour in an adult simulating an adrenal mass with MRI findings and histopathological correlation.

Sacroiliitis and polyneuropathy during isotretinoin treatment

Isotretinoin, a medication for acne, has been reported to cause a variety of side effects on the musculoskeletal system. We present a case of sacroiliitis (a relatively uncommon feature) and sensorimotor demyelinating polyneuropathy, which has been reported previously in only a few cases during isotretinoin therapy. Clinical symptoms were improved after the withdrawal of isotretinoin and the follow-up electrophysiological study performed 2 years after the initial diagnosis of polyneuropathy showed mild improvement. Dermatologists are advised to be alert to symptoms of polyneuropathy and sacroiliitis during treatment with isotretinoin.

The Relationship Between Magnetic Resonance Imaging Findings and Postural Maneuver and Physical Examination Tests in Patients With Thoracic Outlet Syndrome: Results of a Double-Blind, Controlled Study

OBJECTIVES

To investigate the differences in findings from magnetic resonance imaging (MRI) in the neutral and provocative positions, and to examine the relationship between these differences and the results of physical examination tests in patients with thoracic outlet syndrome (TOS).

DESIGN

Prospective.

SETTING

University physical medicine and rehabilitation outpatient and radiology clinics.

PARTICIPANTS

Twenty-nine patients and 12 healthy controls. All of the patients had positive bilateral TOS stress tests; control group participants were symptom free and had negative TOS stress tests bilaterally.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

All participants underwent Adson's test, the Halsted maneuver, and a hyperabduction test. All were evaluated with MRI while in 2 positions: the neutral position (upper extremities adducted) and in a provocative position. Measurements were obtained at the interscalene triangle, at the costoclavicular space, and at the retropectoralis minor space.

RESULTS

There was a significant difference in MRI findings between the neutral and provocative position in the patients (P<.05), but there were no significant differences in the control group. There was a significant difference in the positional change values in MRI between the patients and the control subjects (P<.05). The difference was found in the minimum costoclavicular distance between patients with a positive Halsted maneuver and a negative Halsted maneuver (P<.05).

CONCLUSIONS

Our findings indicate that MRI findings in patients in a provocative position are more valuable in the diagnosis of TOS, and these findings are in accord with findings from the physical evaluation tests.

Acquired spontaneous intercostal abdominal hernia: case report and a comprehensive review of the world literature

Intercostal hernias develop most often as a result of a blunt or penetrating thoracoabdominal trauma. We know of no prior report of a spontaneously occuring intercostal hernia. This study presents a review of the published literature that deals with this uncommon phenomenon, along with a discussion of our patient's clinical presentation and imaging findings.

The effects of monocrotophos to different tissues of freshwater fish Cirrhinus mrigala

The histopathological effects of monocrotophos on the gill, kidney and intestine tissues of the Cirrhinus mrigala were determined by light microscopy. The changes in the gills were characterized by epithelial hyperplasia, aneurysm, epithelial necrosis, desquamation, epithelial lifting, oedema, lamellar fusion and curling of secondary lamellae. Pycnotic nuclei in tubular epithelium, hypertrophied epithelial cells of renal tubules, contraction of the glomerulus and expansion of space inside the Bowman's capsule were observed in the kidney tissues of fish after exposure to monocrotophos. In the intestine tissues of fish exposed to monocrotophos, oedema, necrosis and atrophy of epithelial cells were observed.

Simultaneous onset of hemorrhagic and ischemic strokes

Primary brain hemorrhage and infarction only very rarely occur simultaneously. We report a patient with the simultaneous onset of hemorrhagic and ischemic strokes who had uncontrolled hypertension and atrial fibrillation. Neuroradiologic investigations revealed a large right thalamic hematoma with ventricular extension and an infarct in the territory of the left internal carotid artery. The patient died at the end of the second day because of herniation in spite of anti-edema and antihypertensive medication.

Granulomatous hypophysitis: presentation and MRI appearance

Granulomatous hypophysitis (GrHy) is a relatively rare inflammatory disease compared with lymphocytic hypophysitis. Only a few cases with magnetic resonance imaging (MRI) findings have been reported to date. We describe the MRI findings for two patients with GrHy with unusual histories and clinical outcomes.

Pleurosubcutaneous fistula presenting as lateral thoracic lump in an oncologic patient

We describe a case of pleurosubcutaneous fistula of the left thoracic wall in an oncologic female patient. She presented with left-sided pain and a chest wall mass bulge suspicious for breast neoplasm metastasis.

Oncocytic carcinoma of the parotid gland

BACKGROUND

Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy.

CASE REPORT

A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months.

CONCLUSION

For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.

Comparison of serum IL-1 beta, sIL-2R, IL-6, and TNF-alpha levels with disease activity parameters in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic, inflammatory, rheumatological disease affecting primarily the sacroiliac joint and vertebral column, with an etiology that remains obscure. Cytokines are soluble proteins that have specific roles in inflammatory response, arranging the interaction between cells of the immune system both in natural and specific immune reactions. This study was planned to evaluate the relation between the level of cytokines and the clinical and laboratory findings of patients with AS compared to healthy subjects. In this study, we demonstrated increased serum levels of soluble interleukin-2 receptor (sIL-2R), Interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in patients with AS compared with healthy subjects. Only IL-1 beta levels were not increased in AS patients. We found a correlation between C-reactive protein and IL-6 levels and between erythrocyte sedimentation rate and sIL-2R, IL-6 and TNF-alpha levels. Only the sIL-2R level was correlated with Bath AS Metrology Index and Bath AS Functional Index. We suggest that sIL-2R, IL-6, and TNF-alpha may have a role in the pathogenesis of AS and that their serum levels can be used as disease activity parameters and tools for diagnosis.

MRI findings of Wernicke encephalopathy revisited due to hunger strike

BACKGROUND AND PURPOSE

The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings among a group of patients who presented with Wernicke encephalopathy (WE) due to the neurological complications of a long-term hunger strike (HS).

METHODS

MRI studies also including the fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging (DWI) of six male patients with WE aged from 25 to 38 years (mean age 31 years) were evaluated.

RESULTS

In all subjects, T2-weighted sequences, FLAIR and DWI revealed a signal hyperintensity within the posteromedial thalami and surrounding the third ventricle. In particular, on coronal images, the hyperintense areas around the third ventricle showed a suggestive "double wing" configuration. We observed an increased signal on proton-density and T2-weighted images in the mamillary bodies of three patients. Four patients demonstrated additional hyperintensities within the periaqueductal region and/or the tectal plate. At least one lesion area in five of six patients demonstrated contrast enhancement.

CONCLUSION

The consistent imaging findings of our study suggest that MRI is a reliable means of diagnosing WE. Acute WE is sometimes underdiagnosed, yet early diagnosis and treatment of WE is crucial in order to avoid persistent brain damage. MRI, including postcontrast T1-weighted imaging, DWI beneath standardized T2-weighted imaging, and FLAIR sequences may prove to be a valuable adjunct to clinical diagnosis and to provide additional information in acute and/or subacute WE.

The role of contrast-enhanced MR angiography in the assessment of recently ruptured intracranial aneurysms: a comparative study

We evaluated contrast-enhanced MR angiography (MRA) for the identification of recently ruptured cerebral aneurysms. We studied 23 aneurysms in 18 patients (age range 34-72 years) with aneurysms of the anterior (n = 17) and posterior (n = 6) circulation by comparing 3D time-of-flight (TOF), contrast-enhanced MRA and digital subtraction angiography (DSA). In four of 23 aneurysms, 3D-TOF did not show the lesion. Contrast-enhanced MRA successfully depicted all aneurysms except one. T1 contamination artefacts from subarachnoid or intraparenchymal haemorrhages were evident on the 3D-TOF images in six cases. The artefacts were completely eliminated on the contrast-enhanced MRA images by subtraction of the pre-contrast images. The diagnostic information in patients with subarachnoid haemorrhages (SAHs) provided by contrast-enhanced MRA was comparable to that provided by DSA.

Bone Flap Prefabrication

The usual method to prefabricate a bone flap is to harvest a nonvascularized bone graft and to implant the artery and vein bundle between segments of bone graft. The basic problem of this method is sacrificing an artery for prefabrication. Another method for creating flap donor sites without using an artery is venous flap prefabrication. There are a few articles describing bone flap prefabrication, and these include implantation of both artery and vein as a vascular bundle. Also, there is no experimental study in the literature using a vein or an arterialized vein pedicle for bone flap prefabrication. As an experimental model for bone flap prefabrication, the rabbit ear vascular model was chosen. For the experiments 3 groups were formed. Each group contained 5 rabbits. In the first experimental group a vein was implanted between the halves of bone graft. In the second experimental group an arterialized vein was implanted between the halves of bone graft. To compare the viability of the bone graft of the 2 prefabrication groups, a bone graft was implanted into the subcutaneous pocket of the posterior auricular area in the third group. The authors examined 5 rabbits in each group by microangiography at the end of 6 weeks except for group 3. On microangiographic analysis, groups 1 and 2 showed patency of the vascular pedicle. There was no difference between these 2 groups from the point of view of vascular patency and bone appearance. Bone scintigraphy was performed for 5 rabbits in each group. On bone scintigraphic scans, the bone component of the flaps was visualized in groups 1 and 2, but not in group 3. A quantitative analysis of images was performed by drawing symmetric spherical regions of interest (ROIs) over both the implanted area and cranial bone. The uptake ratios were computed by dividing the mean counts in the implanted ROI by mean counts in the cranial bone ROI. The mean value was 0.86 +/- 0.02 in group 1 and 0.86 +/- 0.04 in group 2. A statistically significant uptake difference was not seen between venous and arterialized venous groups (P < 0.01). Histologic examination was performed all rabbits in each group, and demonstrated that the bony component was viable, showing osteocytes containing lacunae, osteoblasts along bony trabeculae, and vascular channels in groups 1 and 2. In group 3, the bony architecture of the graft was still apparent, but all bone within it was dead. There were no significant microangiographic, histologic, and scintigraphic differences between the 2 experimental methods.

Sequential pulmonary effects of radiotherapy detected by functional and radiological end points in women with breast cancer

AIMS

To determine the pulmonary effects of locoregional irradiation on clinical and sub-clinical radiographic and functional end points in women with breast cancer, and whether the course of these end points is affected by laterality.

MATERIALS AND METHODS

Twenty patients (10 irradiated on the left side and 10 irradiated on the right side) were prospectively evaluated for changes in pulmonary function tests, Tc-99m DTPA (diethylenetriamine pentaacetic acid) lung clearance scintigraphy and high-resolution computed tomography (HRCT) at 6, 16 and 52 weeks after radiotherapy. Tc-99m DTPA clearance, expressed as the biological half-time, T(1/2), was computed from the time-activity curves for 10 min for each lung. The irradiated lung volume was calculated for each patient.

RESULTS

The mean irradiated lung volume was 6.4% +/- 2 (range 3-11%) for the entire population. In the whole study population, two (10%) patients, who were irradiated on the left side, had mild symptomatic radiation pneumonitis in the follow-up period. There was a statistically significant gradual reduction in all pulmonary function test values during the follow-up period. For patients irradiated on the left side, Tc-99m DTPA clearance T(1/2) values were statistically significantly decreased during the follow-up period (P = 0.03), but the decrease was not statistically significant for patients irradiated on the right side (P = 0.62). Tc-99m DTPA clearance T(1/2) values were statistically significantly decreased in the irradiated lung compared with the opposite lung, and no improvement was seen at week 52 after radiotherapy. The number of patients with changes on HRCT scans increased after radiotherapy, reaching a maximum at 16 weeks, when 80% of patients had changes. There was subsequent partial recovery 52 weeks after radiotherapy.

CONCLUSION

Locoregional irradiation for breast cancer may cause sub-clinical irreversible impairment of radiological and functional pulmonary parameters. The increase in clearance rate of Tc-99m DTPA may be more prominent for patients with left-sided breast cancer.

Inflammatory pseudotumor of the spleen with EBV positivity: report of a case

Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36-yr-old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein-Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.

Evaluation of tumor angiogenesis with contrast-enhanced dynamic magnetic resonance mammography

The goal of this research was to correlate dynamic magnetic resonance (MR) mammographic contrast enhancement and microvessel densities in breast masses. Forty-six female patients with breast masses detected by mammography and/or ultrasonography were included in the study. MR contrast enhancements of the lesions were investigated dynamically using axial three-dimensional fast low-angle shot sequences. After excisional biopsy or mastectomy, immunohistochemical staining with factor VIII-RA was performed, followed by microvessel density measurements. Contrast enhancement patterns in dynamic MR mammography were compared with microvessel density measurements using Student's t-test, Pearson's moment correlation coefficients, and one-way analysis of variance (ANOVA). Malignant lesions exhibited three different enhancement patterns: 1) a peak enhancement within 120 seconds (early phase), followed by a decrease in the delayed phase (25 cases); 2) an increase in the early phase, followed by a plateau in the delayed phase (9 cases); and 3) an increase throughout the examination without any peak (5 cases). In benign lesions, signal intensity did not exhibited a peak in five cases, whereas in two cases enhancement was increased in the early phase and made a plateau in the delayed phase. A significant correlation was found between microvessel density and the percentage of maximal signal increase following paramagnetic contrast administration (r=0.322, p<0.05). Dynamic enhancement patterns and rates of maximal signal increase predict microvessel density in breast malignancies and may possibly be used as prognostic indicators.

Asymptomatic choroid plexus cysts in the lateral ventricles: an incidental finding on diffusion-weighted MRI

We assessed the role of diffusion-weighted imaging (DWI) in the detection of choroid plexus cysts. We reviewed more than 1000 patients who had undergone MRI in a 1-year period. We reviewed echo-planar DWI with b=1000 s/mm(2), acquired at 1.0 tesla, for any difference in signal intensity which might indicate choroid plexus cysts. On conventional images, all cystic lesions were isointense with cerebrospinal fluid, and 72 cysts could not be identified. On DWI, 90 rounded high-signal foci were detected in 58 patients; 64 cysts were bilateral. Focal ventricular expansion due to large cysts was observed in nine cases. DWI were found to show choroid plexus cysts undetected within the cerebrospinal fluid on conventional images.