Comparison of Ultrasound Guided Optic Nerve Sheath Diameter Measurements with Other Cranial Imaging Methods (Cranial Computed Tomography and Magnetic Resonance Imaging) in Pediatric Intensive Care Patients

Introduction:Optic nerve sheath diameter (ONSD) measurements aid in diagnosis of increased intracranial pressure (ICP). Computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used modalities for detecting ICP. Lately, ONSD measurements via ultrasound (US) are getting popular as an alternative method due to the ease of performance at the bedside and repeatability. Our study objective was to investigate whether US measurements correlated with CT/MRI counterparts.Methods:This was a single-center, prospective study. All intubated patients aged 1 month-18 years with a cranial CT/MRI for any indications, who could be scanned ultrasonographically, were included after parental consent. Optic nerve US was performed by a single investigator. CT/MRI ONSDs were measured by a neuro-radiologist. Data obtained from US and CT/MRI scans were compared.ResultsA total of 94 different measurements were obtained. The mean ONSD in US and CT was 4.56±0.66 cm and 4.65±0.72cm on the right side, whereas the mean left ONSD was 4.52±0.63 cm and 4.46±0.67 cm, respectively (p=0.4). Correlation coefficient for right ONSD was r=0.448 (p=0.002) while it was r=0.448 (p=0.001) for left ONSD. Both CT and US measurements showed a linear increase, and the correlation between them was moderate. A subgroup of 8 patients who had less than 5 hours between their central imaging and US scan showed strong correlation between measurements for both right and left ONSD [r=0.774, (p=0.024) and r=0.811 (p=0.014), respectively].Conclusion:There was a correlation between US and CT/MRI ONSD measurements in our study. The correlation was stronger when the time interval was less than 5 hours between measurements. Our findings suggest that US may be a useful, reliable and cost-effective method for assessment and clinical follow-up of increased ICP in intubated pediatric intensive care unit patients

Karpal tünel sendromunun tanısında ve tedavi başarısının değerlendirilmesinde ultrasonografi ve ‘strain’ (gerinim) elastografinin rolü i

ve ANAHTAR SÖZCÜKLER AMAÇ: En sık rastlanan tuzak nöropati sendromu olan Karpal tünel sendromunun (KTS) tanısında ve steroid enjeksiyonu ile tedavi başarısının saptanmasında prospektif olarak Ultrasonografi (USG) ve Ultrasonografik Elastografi’nin (UE) etkinliğini araştırmayı amaçladık. GEREÇ ve YÖNTEM: Çalışma Ağustos - Ekim 2014 tarihleri arasında Radyoloji ve Fizik Tedavi ve Rehabilitasyon (FTR) kliniklerinde gerçekleştirilmiştir. Çalışma grubuna dahil olan 25 hastanın 2’si (% 8.0) erkek, 23’ü (%92.0) kadındı ve yaşları 29-68 arasında (ortalama yaş 45.68±10.156) değişmekteydi. Sağlıklı bireylerden oluşan kontrol grubunu 32-58 yaşları arasında değişen (yaş ortalaması 40.820±7.667) 15 kadın (%88.2 ) ve 2 erkek (%11.8) oluşmaktaydı. Kontrol ve çalışma gruplarına USG ve UE kriterleri olan Median sinir alan ölçümleri (MSA, pMSA, fMSA), İntrakarpal içerik alanı (İKA), Karpal tünel içeriği (KTİ) ve Median sinirin (MS) strain değerlerinin ölçümleri yapılarak kayedildi. Çalışma grubu aynı zamanda Boston anketi, VAS ve Sinir ileti çalışmalarıyla da değerlendirildi. Çalışma grubunda olan 9'u bilateral olmak üzere 23 hasta toplam 33 el bileğine değerlendirmelerinin hemen sonrasında aynı gün içinde steroid enjeksiyonu yapıldı. Enjeksiyondan 6 hafta sonra Boston anketi, VAS, Sinir ileti çalışmaları, USG ve UE ölçümleri tekrarlandı. Parametrelerin gruplar arası karşılaştırmalarında Mann Whitney U testi, Median sinir alanı açısından eşik değeri belirlemek için Roc Curve (ROC Eğrisi) analizi ve parametrelerin grup içi tedavi öncesi ve sonrası karşılaştırmalarında ise Wilcoxon işaret testi kullanıldı. p<0.01 değeri anlamlı olarak kabul edildi. BULGULAR: Kontrol grubunda MSA ortalaması (7.33±1.31) çalışma grubuna göre (15.44±5.10); anlamlı olarak düşüktü (p=.00<.05). KTS’li grupda fMSA ortalaması (8.91±4.93) asemptomatik bireylere oranla (1.58±0.75) anlamlı yüksekti (Mann Whitney U=24; p=.00<.05). İKA ölçümleri KTS tanısında anlamlı bulundu (Mann Whitney U=373.5; p=.00<.05). Elastografik değerlendirmede semptomatik olgularda MS ve KTİ’nin strain indeksleri kontrol grubuna oranla anlamlı yüksekti (p=.00<.00 ve P=.036<.05). Tedavi sonrası değerlendirmelerde MSA ve fMSA değerlerinde azalma anlamlıydı (p=.000<.01). MS elastisitesinde anlamlı değişiklik bulunmazken, steroid enjeksiyonu sonrasında KTİ’nin strain indeksinin ortalaması (3.621±1.054) tedavi öncesine (4.680±1.664) oranla anlamlı olarak azalmıştı (p=.002<.01). Tedaviden fayda görenlerde KTİ’nin strain indeksindeki düşüş istatistiksel olarak daha anlamlıydı (p=.001<.01). SONUÇ: KTS tanısında ve tedaviye cevabın değerlendirilmesinde klinik ve elektronörofizyolojik testlere ek olarak gri skala Ultrasonografi ve Ultrasonografik Elastografi yapılmasının yararlı bilgiler sağladığı ve yapılan bu testlerin tamamlayıcı inceleme yöntemleri olduğu kanısındayız. ANAHTAR SÖZCÜKLER: Karpal tünel sendromu, Ultrasonografi, Ultrasonografik Elastografi, Steroid enjeksiyonu ABSTRACT-KEYWORDS ABSTRACT: The aim was to evaluate the added effectiveness of Ultrasonography (US) and Ultrasonographic Elastography (UE) in diagnosis and response to treatment of Carpal Tunnel Syndrome (The most common entrapment neuropatic syndrome) after steroid injection. MEHTODS & MATERİALS: The study was performed from August 2014 until October 2014 in Radiology and Physical Medicine & Rehablitaion clinnics. Two of patients included in case group were male (% 8) and 23 were female (%92). Study group was aged between 29 and 68 years (mean 45.68±10). Control group was consisted of healthy volunteers aged between 32-58 years (mean 40.820±7.667) whom 2 were male ( %11.8) and 15 were female ( %88.2). US and UE criteriae, Median nerve measurements (median nerve area (MNA), proximal median nerve area (pMNA), difference between MNA and pMNA (dMNA)), intracarpal content area (İCA), Carpal tunnel content (CTC) and median nerve strain (MN) values were measured and recorded in both case and control groups. Study group patients were also evalutaed through Boston quetionaire, VAS, nerve conduction studies. Steroid injection was adminstered in 23 patiens (9 of them bilateral wrists, totaly 33 wirsts underwent steroid injection.) at the same day just after ultrasonographic evaluation. VAS, nerve conduction studies US and UE measurements were repeated 6 weeks after steroid injection. Parameters were compared between study and control groups with Mann Whitney U test. In order to set a cut off value for Median Nerve Area, Roc Curve analysis was used. To compare parameters before and after treatment in each group seperately, Wilcoxon test was used. FİNDİNGS: Mean MNA value in control group (7.33±1.31) was significantly (p=< .05) lower then that of case group (15.44±5.10). Mean dMNA in CTS group (8.91±4.93) was significantly (Mann WhitneyU=24; p=.00&lt;.05) higher comparative to healthy volunteers group (1.58±0.75). MN and CTC strain indices was significantly higher in control group (p=.00&lt;.00 ve P=.036&lt;.05). Decrease in MNA and dMSA values after treatment was meaningful (p=.000&lt;.01). While there was not significant change in MN elasticity, mean CTC strain index (3.621±1.054) was significantly decreased (4.680±1.664) after steroid treatment (p=.002&lt;.01). Decrease in CTC index of patients who took the advantage of treatment was more significant (p=.001&lt;.01). RESULT: We believe that Gray scale Ultrasonography and Ultrasonographic Elastography can provide helpful data if used in addition to clinical and electroneurophysiological tests in diagnosis and response to treatment evaluation of CTS patients. KEYWORDS: Carpal tunnel syndrome, Ultrasonography, Ultrasonographic Elastography, Steroid injectio

Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica

Background/aim: The aim of this study was to identify predictive factors for treatment success in transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica

Computed tomography findings of primary epiploic appendagitis as an easily misdiagnosed entity: Case series and review of literature

BACKGROUND: Primer epiploic appendagitis (PEA) is an uncommon condition. METHODS: We retrospectively reviewed the clinical records and computed tomography (CT) findings of 45 patients with PEA. RESULTS: On the basis of physical examination and pain localization, presumptive clinical diagnosis was acute appendicitis (n=13), acute cholecystitis (n=2), acute diverticulitis (n=19), renal colic (n=7) and ovarian pathology (n=4). CONCLUSION: Although it has no characteristic clinical and laboratory features, CT is the best modality for accurate diagnosis of PEA

Is an interval appendectomy still necessary in perforated appendicitis with inflammatory mass/abcess

We reviewed our experience in non-operative management without an interval appendectomy (IA), for patients who presented with perforated appendicitis with an abcess or inflammatory mass from November 2012 to November 2017 retrospectively. The data included age, sex, duration of symptoms, presence of appendicolith/ abcess on CT imaging, WBC and CRP levels, antibiotic treatment, fever at presentation, percutan drainage procedure and complications, recurrent abscess, total length of hospitalization, follow-up period. A total of 32 patients were treated with nonoperative management during the study period. Nonoperative management without an IA was successful in 31 patients (96%). Study patients included were admitted to the surgical ward for observation. The mean age of the patients was 9.74±3.55 years. 19 male and 13 female patients were included in the study. The mean duration of symptoms was 8.75±4.69 days. The mean number of Ct scans was 1.21±0.42 per patient. Percutan drainage was performed in 10 patients. The mean of WBC levels at presentation was 19030.00±7192.24 cells/&#956;L and CRP levels was 156.61±94.23 mg/dl. Intravenous piperacillin-tazobactam (Tazosin®, Pfizer, New York, NY) were given 400 mg/kg/day in four divided doses. Diet were started to the patients who were afebrile and had diminished abdominal pain during observation. The mean length of hospitalization was 13.03±5.82 days. The mean duration of follow-up period 34.65±20.48 months. Nonoperative management without IA is a preferable choice for perforated appendicitis with abcess or mass. [Med-Science 2018; 7(4.000): 781-4

The Significance of the Contralateral Testis Size Measurement with Ultrasonography in Predicting Monorchism in Boys with Nonpalpable Testicles

Objective: The aim of this study was to determine the significance of contralateral testis size in predicting monorchism in pediatric patients with unilateral undescended testis. Materials and Methods: The data of patients who underwent surgical operation by a single pediatric urologist for undescended testis between 2013 and 2016 was evaluated retrospectively. The patients were grouped as having monorchism (M), nonpalpable intra-abdominal testis (NPIAT), and palpable undescended testis (PUDT). The dimensions of the testes were measured ultrasonographically and recorded before operation. Patients with nonpalpable testis underwent diagnostic laparoscopy and patients with PUDT underwent inguinal orchiopexy. Results: A total of 57 children with a mean age of 31 (11-60) months were evaluated. Of the children, 12 had M, 9 had NPIAT and 36 had PUDT with a similar mean age (p>0.05). The size of the descended testis was found to be significantly small in NPIAT* and PUDT** groups compared to the M group (*p0.05). Conclusion: The size of the testis in the scrotum might help to localize the position of the undescended testis