Urgent arterial embolization of ruptured renal angiomyolipoma

The most undesired complication of renal angi- omyolipoma (AML) is bleeding. Because of tumor rupture, the bleeding can spread to the retroperitoneal field and can be severe enough to be life threatening. We report a case of retroperitoneal hemorrhage caused by a ruptured AML that was successfully treated with transarterial embolization with N-butyl cyanoacrylate

A case of massive dystrophic cardiac calcinosis with increased bone resorption markers: A novel pathophysiologic link?

We report a 72-year-old man who presented to our emergency room with congestive heart failure that was resistant to initial medical therapy. He had suffered from anterior myocardial infarction 20 years prior. Echocardiography and computed tomography revealed marked cardiac calcification including myocardium, chordal structures, mitral annulus, and aortic valve. Neither chronic renal insufficiency nor hypercalcemia were present in our patient. Bone resorption markers were increased and bone mineral density was consistent with severe osteoporosis. We suggested a novel mechanism, that increased bone resorption may lead to accumulation of calcium into avascular tissues in the heart (ie, chordal structures, mitral annulus, aortic valve, and fibronecrotic myocardium) especially in the setting of high left ventricular end-diastolic pressure. Dystrophic cardiac calcinosis, an age-related cardiomyopathy, is associated with elevated bone resorption markers and it may cause alterations in cellular calcium hemostasis with initiation of deleterious events leading to aggravate dilated and restrictive cardiomyopathy and may result in intractable congestive heart failure. The implication of this case report needs to be reemphasized

The importance of volume and area fractions of cerebellar volume and vermian subregion areas: a stereological study on MR images

Purpose: Age, gender, and body size are important factors which are affecting the cerebellar volume (CV). Many neurological diseases lead changes in CV. The aim of this study is to measure CV and the total intracranial volume (TIV) for both genders on magnetic resonance images (MRI), to calculate the CV/TIV volume fraction, and also to determine the normal values that can be regarded clinically significant by determining the total vermis area and vermian subregion areas (V1, V2, and V3). Methods: In this retrospective study, MR images (without any pathological findings) of 200 individuals (100 female, 100 male) between the ages of 20–40 were used. CV and CV/TIV volume fractions, vermian subregion areas, and area fractions were calculated by using the Stereoinvestigator 8.0 (Microbrightfield, USA) software. The volumetric calculations were performed by the point counting method according to the Cavalieri principle, which is one of the volume calculation methods in stereology. Total CV, TIV, cerebellar vermis areas (V1, V2, and V3), and total cerebellum area were measured separately for both groups. Results: The volume of cerebellum was 120.53 ± 11.1 cm3 in males, 105.99 ± 11.2 cm3 in females, TIV was 1304.99 ± 91.7 cm3 in males and 1155.15 ± 85.7 cm3 in females. CV and TIV were statistically higher in males (p = 0.001, p = 0.001 respectively). It was observed that the differences between the genders in terms of CV/TIV disappeared (p = 0.679). The total vermis area was 11.59 ± 1.3 cm2 in males and 10.85 ± 1.3 cm2 in females. V1 area, V3 area, and the total vermis area were found statistically higher in males (p = 0.05, p = 0.006, p = 0.007 respectively). It was determined that the area fraction of V2 was higher in females when the fractions of V1, V2, and V3 to the total vermis area were examined (p = 0.03). Conclusion: We believe that the normal values of CV, TIV, and vermian subregion areas, determined by stereological method, will contribute to the diagnosis and the treatment plan of the clinical pathological evaluations in adults and children. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

Traumatic bilateral vertebral artery dissection at the dural entry point site in a 10-year-old boy

We present a 10-year-old boy who was admitted with headache and neurological symptoms after a trauma in the schoolyard. Cerebral MRI revealed an extensive ischaemia in the bilateral cerebellar hemispheres, left middle cerebellar peduncle, and right vermis. Digital substraction angiography demonstrated bilateral vertebral artery dissections at the dural entry point site. This case emphasises the management of patients with traumatic vertebral artery dissection

Utility of F-18 fluorodeoxyglucose positron emission tomography/computed in carcinoma of unknown primary

Carcinoma of unknown primary (CUP) is a heterogeneous group of tumors with various clinical features causing diagnostic and therapeutic challenges. The aim of this study was to evaluate the ability of F-18 FDG PET/CT for localizing the primary tumor, disclosing additional metastases, and changing the treatment in patients with CUP. One hundred and twelve metastatic patients (female = 40, male = 72, median age = 60.5 years) in whom conventional diagnostic work-up failed to disclose the primary tumor were included in the study. F-18 FDG PET/CT imaging was performed in a standard protocol (patient supine, arms on patient's side, vertex to thigh, 369.3 MBq (296-444 MBq) F-18 FDG, a 60-minute uptake period, 6-7 bed position). Histopathology was taken as the only reference standard. F-18 FDG PET/CT correctly detected primary tumor in 37 of 112 (33.03%) patients. The most common site of primary tumor detected by F-18 FDG PET/CT was lung (n = 18), which was followed by nasopharynx (n = 7), pancreas (n = 5), tonsil (n = 2), breast (n = 2), thyroid (n = 1), uterus (n = 1) and colon/rectum (n = 1). F-18 FDG PET/CT imaging disclosed additional previously undetected metastases in 32 (28.5%) and changed the treatment in 33 (29.4%) of 112 patients. There were false positive F-18 FDG PET/CT results in 21 (18.5%) patients. F-18 FDG PET/CT is able to disclose the primary tumor, disclose new metatases and change the treatment in about one third of patients with CUP

Multifocal Insulinoma in Pancreas and Effect of Intraoperative Ultrasonography

Insulinoma is the most frequently seen functional pancreatic neuroendocrine tumor. The incidence of multifocal insulinoma is lower than 10%. Its treatment is direct or laparoscopic excision. The present case was examined with the findings of hypoglycemia and hypercalcemia, and as there was high insulin and C-peptide levels the initial diagnosis was insulinoma. The case was investigated in terms of MEN 1. During preoperative screening for localization, there was one focus in the head of the pancreas in the abdominal tomography and two foci in endoscopic ultrasonography. No other focus was detected through intraoperative visual or manual palpation. However, five foci were detected during operation by intraoperative ultrasonography. The relation of masses with the main pancreatic canal was evaluated and they were excised by enucleation method. There was no recurrence during the postoperative 18-month follow-up of the patient. As a result, during treatment for insulinoma, it should be kept in mind that there might be multifocal foci. In all insulinomas, the whole pancreas should be evaluated with intraoperative ultrasonography because none of the current preoperative diagnostic methods are as sensitive as manual palpation of pancreas and intraoperative ultrasonography. The intraoperative detection of synchronous five foci in pancreas is quite a rare condition