Executive functions and thyroid volumes in bipolar patients on lithium treatment

Aim: The purpose of this study was to investigate the relationship between executive functions and thyroid ultrasound parameters in remitted bipolar patients who were on lithium treatment. Methods: In the current study, 25 remitted patients with diagnoses of Bipolar I Disorder having blood lithium, and thyroid hormone levels within the normal range were consecutively enrolled. Healthy control group consisted of 25 euthyroid people matched as an age, sex and education level with the patients. Semi-structured sociodemographic and clinical form, the Structured Clinical Interview for DSM-IV Axis I Disorders, the Montreal Cognitive Assessment (MoCA), the Hamilton Depression Scale, Young Mania Rating Scale, thyroid ultrasonography and the Wisconsin Card Sorting Test (WCST) were applied to both groups. Within the patient group, correlation analysis was performed between WCST performance and thyroid volume. Results: In the present study, no significant difference was found between the bipolar and the healthy control groups regarding the executive functions as measured via WCST. In the bipolar patients, there were no statistically significant correlations among WCST scores and thyroid volumes. Conclusion: Thyroid volumes are not appeared to be associated with executive functions in euthymic bipolar patients.Publisher's Versio

Modern aspects of Josephson dynamics and superconductivity electronics

In this book new experimental investigations of properties of Josephson junctions and systems are explored with the help of recent developments in superconductivity. The theory of the Josephson effect is presented taking into account the influence of multiband and anisotropy effects in new superconducting compounds. Anharmonicity effects in current-phase relation on Josephson junctions dynamics are discussed. Recent studies in analogue and digital superconductivity electronics are presented. Topics of special interest include resistive single flux quantum logic in digital electronics. Application of Josephson junctions in quantum computing as superconducting quantum bits are analyzed. Particular attention is given to understanding chaotic behaviour of Josephson junctions and systems. The book is written for graduate students and researchers in the field of applied superconductivity

Renal artery stenting using CO2 gas angiography in patients with chronic renal insufficiency

ABSTRACTBackground: Renal artery stenosis (RAS) is the most common cause of secondary hypertension.Significant stenosis causes poor control of hypertension, worsening of renal function, left ventriclehypertrophy and heart failure. The goal of renal artery revascularization is to preserve renal function,improve the blood pressure (BP) control and prevent cardiovascular complications. Renal artery (RA)stenting proved to be a safe minimally invasive treatment, which may improve BP control andpreserve renal function. Contrast-induced nephropathy (CIN) is one of the most seriouscomplications caused by iodinated contrast angiography. Because the feasibility and safety of CO2angiography-guided renal artery stenting have been reported, CO2 angiography is expected toreduce CIN. The aim of this study was to evaluate the safety of CO2 as contrast agents duringangiography in the diagnosis and percutaneous treatment of RAS in patients with chronic renalinsufficiency.Materials and Methods: Patients who underwent renal artery stenting using CO2 angiography withchronic renal insufficiency (serum creatinine level &gt; 1.5 mg/dL) in a single center were retrospectivelyreviewed. Patients were referred for angiography and potential percutaneous revascularization onthe basis of the clinical history, physical and radiologic examination. The diagnostic CO2angiography was performed as previously described. Arterial access was obtained via the commonfemoral artery. The collection syringe volume was typically set at 20 ml for flush aortograms (todeliver 60 ml of CO2) with a two-way stopcock. Angioplasty procedures using balloon-expandablestents were performed according to standard interventional techniques. Baseline and follow-upclinical data including patient demographics, comorbidities, laboratory tests, number and types ofanti-hypertensive medications, indications for the procedure and complications were collected fromthe medical notes and hospital information system.Results: A total of 35 patients (26 males and 9 females; mean age 71.97 ± 7.42) were incorporatedinto the study. Diabetes mellitus was present in 31.5% of patients. Creatinine level and mean eGFRat baseline were 1.8 and 37.7 mL/min/1.73m2 respectively. The procedural and angiographicsuccess rate was 100%. There were no severe complications. One puncture site complication(hematoma) occurred. One patient developed chest pain but recovered uneventfully. After theprocedure, eGFR increased to 42.30 ml/ min/1.73m2 and serum creatinine level decreased to 1.66.Discussion and Conclusion: The use of CO2 as an angiographic contrast agent in pa- patientswith suspected renal artery stenosis and ischemic nephropathy is a safe alternative to the use ofiodinated contrast material. CO2 does not result in an increase in the incidence of complicationscompared with iodinated contrast material.&nbsp;</div

Günlük pratikte ve zorlu vakalarda VIRADS

Background:Bladder cancer is the 10th most common cancer type all over the World. (1)In 2022 an estimated 81,180 adults (men are at higher risk four times) will be diagnosed with bladder cancer. The classic presentation of urothelial carcinoma gross hematuria in elderly men. (2)Nevertheless, in current treatments, mortality rates depend on early diagnoses. The most critical prognostic factor in determining the presence of muscle invasion. Urothelial tumors are classified as either invading muscle (nonpapillary) or not invading muscle (superficial or papillary ) (1) (Table -1).&nbsp;The luminal protrusion may be revealed by cystoscopy, but muscular layer invasion or extension to adjacent organs may be detected by MRI. VI-RADS is a structured reporting system for suspected bladder cancer. It was proposed in 2018(3).The assessment of bladder lesions is based on multiparametric MRI (mpMRI) findings. High-resolution T2-weighted imaging (T2WI) sequences, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) provide critical information for the evaluation of bladder lesions. (1)(Figure.1)Although non-muscle invasive bladder cancers (NMIBC) can be managed with transurethral resection of bladder tumor (TURBT) (3). Radical cystectomy is the common treatment choice for muscle-invasive bladder cancer (MIBC). VI-RADS aims to discriminate between NMIBC from MIBC, also VI-RADS score as a predictor of re-excision risk in patients with high-risk NMIBC (1).Findings and procedure details:The staging of bladder lesions is based on the assessment of muscle invasion. The detrusor muscle appears as a low signal intensity line on T2WI along the bladder wall with intermediate signal intensity on DWI, but no early enhancement on DCE(1). The presence of an interruption in this hypointense line is significant for muscle invasion.&nbsp; (Figure.2) DWI can identify regions of diffusion restriction, which characteristically is seen in urothelial carcinoma; this tumor appears hyperintense on DWI with corresponding hypointensity on the apparent diffusion coefficient (ADC) map.Each malignant lesion is assigned a score from 1 to 5 in three categories: structural category (SC) on T2WI(Table.2), DCE (Table.3), and DWI (Table.4). &nbsp;The score corresponds to highly unlikely [1], unlikely [2], equivocal [3], likely [ 4], and very likely [5] Detrusor muscle invasion. (Figure 3-8 &nbsp;)Using mpMRI with a novel standardized reporting system has many potential clinical applications. The high diagnostic accuracy makes it a candidate for staging individuals with urothelial carcinoma and identifying high-risk individuals who may need re-TURBT or proceed to radical cystectomyConclusion:VI-RADS helps radiologists become aware of what to consider when staging. This system also helps departments introduce structured reportingReferences:1-Brian S. Wong, Cihan Duran, Stephen B. William; Vesical imaging reporting and data system (VI-RADS) and impact on identifying the depth of invasion with subsequent management in bladder cancer patients; .doi.org/10.21037/tau-20-839 &nbsp;2-Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.3-Barchetti G, Simone G, Ceravolo I, et al. Multiparametric MRI of the bladder: inter-observer agreement and accuracy with the Vesical Imaging-Reporting and Data System (VI-RADS) at a single reference center. Eur Radiol 2019;29:5498-506.</p

Craniocervical junction abnormalities(CJA) in pediatric patients with a genetic disorder

Title : Craniocervical junction abnormalities(CJA) in&nbsp; pediatric patients with a genetic disorder&nbsp;PURPOSE:To evaluatecraniocervical junction abnormalities(CJA) in pediatric patients witha genetic disorder&nbsp;&nbsp;METHODS orBACKGROUND:Thecraniovertebral junction connects the skull and cervical spine. İt is abiomemechanically complex articulation consist of the occipital condyles (Oc) the atlas (C1) andaxis (C2) [1].&nbsp;Children are more susceptible to craniocervicalinstability due to their larger head size, flexible joints and ligaments, and ashallower facet joint. [2]. &nbsp;The distance betweenthe anterior surface of the dens and the posterior surface of the tubercle inchildren should be less than 5 mm. This space is also known as 'Predentatespace'. If the predentate space is measured more than 5 mm, we should consideratlantoaxial instability. However, in chronic atlantoaxial conditions (eg.Downsyndrome, congenital anomalies), the predentate space is less valuable [1].(Figure 1 )&nbsp;&nbsp;There are several ways a subluxation can occur . Anteroposteriorsubluxation , rotatory subluxation, &nbsp;vertical subluxation and lateralsubluxation [3]&nbsp;. Rotatory subluxation is characterized into fourdifferent types according to the the Fielding and Hawkins classification (Figure2 )&nbsp;CJA &nbsp;are generally due to one of threebiomechanical features , instability, deformity and neuraxial compression[1] .İnstability&nbsp;&nbsp; occurs when the structuralcompromise of the Oc-C1-C2 articulation allows movement outside physiologicallimit [1] &nbsp;. Generally, ligament laxityis responsible for instability and this condition more common in atlantoaxialjoint [4] . Espicially in the Down Syndrome population the ligamentlaxity due to intrinsic collagen defects or chronic inflammation leading toweakness and cause instabiliy[2](Figure 3 ) .&nbsp; Anatomical and rotational deformity can alsocontribute to craniocervical junction abnormalities[1] In achondroplasiathere is a marked discrepancy in relative size between skull vault and the skull base [1] . Since &nbsp;the&nbsp;skull base&nbsp;forms by&nbsp;endochondral ossification&nbsp;whereas the skull vault bymembranous ossification, As a result of this size discrepancy, stenosis occursin the foramen magnum, and interruption of normal cerebrospinal fluid (CSF)flow may lead to hydrocephalus (Figure 4 ) . &nbsp;Neuraxial compression is often causedby basilar impression&nbsp; and intussusception[5] . İf the dens is positionedabove the caudal borders ,basilar impression occurs. Basilar invagination isdiagnosed when the dens protrudes&nbsp;superior to McRae’s line [6] .Neuraxial compression can cause serious neurologic damage because of brain stemcompression .&nbsp; Basilar invagination,basilar impression, and platybasia &nbsp;havebeen observed in 37% of patients with Osteogenesis Imperfecta ( Figure 5).&nbsp;&nbsp;RESULTS orFİNDİNGS:The risk ofcraniocervical junction stenosis is increased in genetic disorders (Table 1 )We describe the craniocervical junction stenosis that wedetected in asymptomatic patients who have no trauma history . We present craniocervicaljunction stenosis cases withDown syndrome (Figure 6), Achondroplasia(Figure 7) and&nbsp; Osteogenesis Imperfecta(Figure 5 ).&nbsp;&nbsp;CONCLUSİON:Althoughcraniocervical junction stenosis is not always symptomatic, it is important torecognize to prevent further physical and possible neurological damage.&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img 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An Ankylosing Spondylitis Case Which Accompanies Portal Hypertension and Lichen Amyloidosis

In this paper, we present a case that has been followed with Ankylosing Spondylitis (AS) for forty years and developed diabetes, iridocyclitis, lichen amyloidosis and hypertension over time. A 73-year-old male patient presented to our hospital with dyspnea and massive ascites with portal hypertension in the last one year. Cardiac and hepatic venous pressure measurements revealed mild pericardial thickening and intrahepatic sinusoidal portal hypertension in the liver. An infiltrative reason as metabolic, viral, autoimmune to develop portal hypertension was not found and systemic inflammation and vascular involvement due to AS was thought. TIPS was applied to the patient due to resistant ascites. After this operation, albumin was not needed, acid regressed and general condition improved. We aimed to present a very rarely seen association of AS, lichen amyloidosis and portal hypertension, and the curative result of TIPS operation in this case

Vakalarla olgu sunumları: Akut skrotum, acil alarm

Background:The acute scrotum is a clinical feature that is characterized by symptoms such as pain, swelling, and redness in the scrotum and requires urgent diagnosis and intervention. The aim of this study is to reveal the typical imaging findings detected in ultrasonography (US), which is the imaging method frequently and primarily used in the differential diagnosis of clinical conditions causing acute scrotum.Findings and procedure details:We will present cases of testicular torsion, torsion of the appendix testis,epi-didymo orchitis, and testicular abscess, which may be confused with a mass lesion. Testicular torsion often results from the rotation of the spermatic cord. Anatomically there are two types of testicular torsion; extra-vaginal (supravaginal) torsion occurs at the level of the outer inguinal ring seen in newborns. İntra-vaginal torsion is more common and typically occurs in adolescents and young adults (1) (Figures 1,2,3).Torsion of the appendix testis is the most common cause of an acute painful hemiscrotum in a child (1). Unlike testicular torsion, medical treatment is often sufficient (Figure 4).We will present cases of testicular torsion, torsion of the appendix testis,epi-didymo orchitis, and testicular abscess, which may be confused with a mass lesion. Testicular torsion often results from the rotation of the spermatic cord. Anatomically there are two types of testicular torsion; extra-vaginal (supravaginal) torsion occurs at the level of the outer inguinal ring seen in newborns. İntra-vaginal torsion is more common and typically occurs in adolescents and young adults (1).&nbsp;Testicular torsion, testis, and spermatic cord&nbsp;twists within the scrotum cause vascular&nbsp;occlusion&nbsp;and&nbsp;subsequent infarction if not corrected immediately (Figure 1,2,3).Torsion of the appendix testis is the most common cause of an acute painful hemiscrotum in a child (1). Testicular appendages are vestigial remnants of the mesonephric andParamesonephric ducts are composed of vascularized connective tissue along the testis and epididymis. Unlike testicular torsion, medical treatment is often sufficient (1)(Figure 4).Epididymoorchitis is also a common cause of acute scrotal pain in adults. The infection usually originates from the bladder or prostate gland spreading to the epididymis through the spermatic cord, eventually reaching the testis, leading to epididymo-orchitis (2). Epididymitis with orchitis occurs in approximately 20% to 40% of cases &nbsp;(2) (Figure 5). Testicular abscess formation is a rare complication of epididymo-orchitis (3) (Figure 6). Clinical history and Doppler findings are critical in the differential diagnosis, as malignant processes are also included in the differential diagnosis of focal testicular lesions(3) (Figure 7)Conclusion:Differential diagnosis of scrotal pain is vital in determining the treatment plan. &nbsp;Ultrasound is the modality of choice. Early imaging is essential in patients presenting with scrotal pain, following a detailed history and physical examination. Especially in cases of testicular torsion, detorsion within the first six hours is vital to preserving the testis's vitality. Therefore, early diagnosis and rapid action are required. It is also emphasized in the literature that scrotal exploration should not have hesitated in cases where torsion cannot be ruled out with imaging methods.References:1-David E. Sweet, &nbsp;Myra K. Feldman, Erick M. Remer; Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders; 2020 DOI: 10.1007/s00261-019-02333-42-Dogra V, Bhatt S (2004) Acute painful scrotum. Radiol Clin North Am 42:349-363.3-Wang CL, Aryal B, Oto A, et al (2019) ACR Appropriateness Criteria: Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol, 16:5:S38-S43</div