Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation

Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation. Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE). The patient’s best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared. Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves

Diffusion-weighted imaging in ectopic pregnancy: Ring of restriction sign

WOS: 000423547100010PubMed ID: 29023142Objective: To demonstrate the diffusion-weighted imaging (DWI) findings of ectopic pregnancy (EP) and introduce the "ring of restriction" sign by discussing possible causes. Methods: Between January 2014 and January 2017, patients with EP and examined by MRI on a 3T scanner were retrospectively evaluated. MRI and DWI findings were recorded. Results: A total of 40 patients were diagnosed with EP at our university hospital, 8 of whom (20%) were evaluated by MRI and DWI. All of them were haemodynamically and clinically stable and could be imaged adequately. Locations were ovary (n = 3, 37.5%), tuba (n = 2, 25%), Caesarean section scar (n = 2, 25%) and parauterine (n = 1, 12.5%). In all eight EPs, the gestational sac diameter was compatible with 7-9 weeks. With DWI, the gestational sac was seen as a thick-walled cyst-like structure. The thick wall showed diffusion restrictions in all patients (ring of restriction sign). Conclusions: DWI through its cellular and molecular evidence may contribute diagnosis of EP

Multisystem imaging findings of a case with relapsing polichondritis

Relapsing polychondritis is a rare immune-mediated systemic inflammatory disease. It is associated with inflammation in cartilaginous tissue and primarily affects cartilaginous structures of the ears, nose and tracheobronchial tree but also the joints, the inner ear, the eyes, and the cardiovascular system (1). With this report we share the multisystem imaging findings of a case with relapsing polychondritis

Importance of fat tissue and puborectal muscle thickness in pelvic floor prolapse and spastic pelvic floor syndrome evaluated by MR defecography

Manyetik rezonans (MR) defekografi ile değerlendirilen olgula- rın klinik ve radyolojik bulgularını sunmak; pelvik taban sarkması (PTS) ve spastik pelvik taban sendromu (SPTS) ile yağ dokusu ka- lınlıkları ve puborektal kas kalınlıkları arasındaki ilişkiyi değerlen- dirmek; PTS alt gruplarının ilişkisini değerlendirmek amaçlandı. Eylül 2015-Eylül 2017 tarihleri arasında MR defekografi ile değer- lendirilen hastalarda retrospektif olarak PTS, sarkmanın hangi kompartmanda olduğu, sarkmanın düzeyi (minimal, orta, ileri), rektosel, invajinasyon, enterosel ve SPTS bulguları değerlendi- rilerek suprapubik, presakral ve rektus abdominus kası anterio- rundaki yağ dokusu kalınlıkları, sağda ve solda puborektal kas kalınlıkları ölçüldü. PTS alt gruplarının (ön, orta, arka) birbirleri ile olan ilişkisi; PTS şiddeti ile suprapubik, presakral ve rektus ab- dominus kası anteriorundaki yağ dokusu kalınlığı arasındaki ilişki Spearman korelasyon testi ile analiz edildi. SPTS olan ve olmayan grupta suprapubik, presakral ve rektus abdominus kası anterio- rundaki yağ dokusu kalınlığı ve sağ-sol puborektal kas kalınlık- ları T testi ile karşılaştırıldı. Altmış üç olguda (ortalama yaş 45; 49 kadın, 14 erkek olgu), 62 arka, 35 orta ve 36 ön kompartman sarkması; 55 rektosel, 28 invajinasyon, 3 enterosel, 1 hipermo- bil üretra, 19 olguda SPTS izlendi. Orta kompartman ile ön kom- partman sarkması arasında kuvvetli bir korelasyon bulundu. Orta kompartman ile rektus abdominus kası anteriorundaki yağ doku- su kalınlığı arasında ve ön kompartman ile rektus abdominus kası anteriorundaki yağ dokusu kalınlığı arasında istatistiksel olarak anlamlı korelasyon saptandı. Ayrıca SPTS grubunda suprapubik yağ dokusu daha ince idi. Orta ve ön kompartman sarkması ara- sındaki güçlü korelasyon, problemin orta kompartmana geçince ön kompartmanı tutmasının kolay olduğunu gösteriyor olabilir. Yağ dokusu kalınlığının artışı orta ve ön kompartman sarkmasın- da etiyolojide obezitenin rol oynayabileceğini göstermekle bir- likte, arka kompartman sarkması ve SPTS’de obezitenin etkisinin belirgin olmadığı şeklinde yorumlanabilir.To present the clinical and radiological findings of cases evalua- ted by magnetic resonance (MR) defecography; to evaluate the relationship between pelvic floor prolapsus (PFP), spastic pelvic floor syndrome (SPFS) and thicknesses of fat tissue and puborec- tal muscles. MR defecograms of the patients evaluated between September 2015 and September 2017 were investigated retros- pectively. PFP, involved compartment, severity of PFP (minimal, moderate, advanced), rectocele, invagination, enterocele and spastic pelvic floor syndrome; thickness of suprapubic, presacral, and pre-rectus abdominus fat tissues, right and left puborectal muscle thicknesses were measured. The correlations among PFP subgroups (anterior, middle, posterior); the relationship between the severity of PFP, and thickness of suprapubic, presacral and pre-rectus abdominus fat tissue was analyzed by Spearman’s cor- relation test. In the groups with and without spastic pelvic floor syndrome, thickness of suprapubic, presacral, and pre-rectus ab- dominus fat tissue and thickness of right-left puborectal muscle were compared by T-test. Of the 63 cases (mean age 45, 49 fema- le, 14 male), 62 posterior, 35 middle, and 36 anterior compart- ment prolapses; 55 rectoceles, 28 invaginations, 3 enteroceles, 1 hypermobile urethra and 19 cases of SPFS were detected. There was a strong correlation between the middle and the anterior compartment prolapsus. There was a statistically significant cor- relation between middle compartment and rectus abdominalis anterior fat tissue thickness and between anterior compartment and rectus abdominus anterior fat tissue thickness. In addition, the suprapubic fat tissue in the SPFS group was thinner. The strong correlation between the middle and anterior compart- ment prolapses can indicate that the anterior compartment is ea- sily affected when middle compartment is involved. The increase in fat tissue thickness may indicate that obesity may play a role in the etiology of middle and anterior compartment prolapsus, but it can be interpreted that the effect of obesity on the posterior compartment prolapsus and SPFS is not so apparent

Dynamic MR Urography in the Asssesment of Ureteropelvic Junction Obstruction in Pediatric Patients

The aim of this study was to determine morphologic and functional benefits of dynamic magnetic rezonans urography (MRU) at pediatric patients with ureteropelvic junction obstruction. Between 2009-2012, sixteen pediatric patients with known ureteropelvic junction obstruction were evaluated by ultrasound and dynamic MRU retrospectively. Eight of them also had diuretic renal scintigraphy. The findings of MRU were then compared with ultrasonography for morphological evaluation, diuretic renal scintigraphy for functional evaluation and against the results of final diagnosis established at surgery. MRU failed in one patient to find obstruction like ultrasound. MRU and ultrasound was successful to evaluate morphology of urinary system all of the other patients. Results were confirmed with surgery. MRU and diuretic renal scintigraphy were similar for functional evaluation. Dynamic MRU is reliable method for morphologic and functional evaliation of pediatric ureteropelvic junction obstruction. [Med-Science 2013; 2(4.000): 863-84

Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?

WOS: 000402802300017PubMed ID: 28339285Objective: To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions. Methods: Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. Results: A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (6 standard deviation) was 1.6160.51 in carcinomas, and it was 0.6560.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. Conclusion: The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field