Intraoperative Doppler ultrasound: A reliable diagnostic method in insulinoma

A 44-year-old woman was admitted with obvious symptoms of hypoglycemia and Whipple's triad during a 6-month period. The glucose level was as low as 32mg/dL and insulin/glucose ratio greater than 0.5 after fasting. Abdominal magnetic resonance imaging (MRI) studies revealed a pancreatic mass at the head, 2cm in diameter that was not suggesting because of hypointensity. Selective angiography and somatostatin-receptor scintigraphy did not reveal insulinoma. During laparotomy the tumor was palpated on the ventral surface of pancreas and intraoperative ultrasound accurately localized it. Doppler ultrasound examination clearly revealed the hyper-vascularity of the tumor, which was suggesting an insulinoma. After the tumor enucleation, blood glucose level increased to normal ranges. Histopathological examination revealed benign, well differentiated neuroendocrine tumor, insulinoma. The postoperative recovery was uneventful and the patient is still symptom free during a follow-up period of 6 months. Doppler ultrasound may be a simple but efficient tool for the differential diagnosis of insuhnoma. If the clinical symptoms and findings suggest clearly an insulinoma, intraoperative Doppler ultrasound examination seems to be a simple but the most sensitive diagnostic method

Magnetic Resonance Imaging of Non-Puerperal Complete Uterine Inversion

Uterine inversion is shortly described as the indentation and depression of the fundic area extending downwards up to the different levels of the birth canal till vaginal opening. Clinical diagnosis of uterine inversion is difficult due to its non-specific symptoms and physical examination. Ultrasonography is the most practical modality for radiological evaluation, but it is inadequate to determine the exact nature of this condition and making the differential diagnosis. In this case, we present the main MRI findings of non-puerperal complete uterine inversion caused by a giant leiomyoma

Magnetic Resonance Imaging of Non-Puerperal Complete Uterine Inversion

Uterine inversion is shortly described as the indentation and depression of the fundic area extending downwards up to the different levels of the birth canal till vaginal opening. Clinical diagnosis of uterine inversion is difficult due to its non-specific symptoms and physical examination. Ultrasonography is the most practical modality for radiological evaluation, but it is inadequate to determine the exact nature of this condition and making the differential diagnosis. In this case, we present the main MRI findings of non-puerperal complete uterine inversion caused by a giant leiomyoma

Histomorphometric examination of long-term changes in temporomandibular joints after mandibular lengthening by distraction osteogenesis in rabbits

donmez, hasan huseyin/0000-0003-4664-8489WOS: 000303402200015PubMed: 22676985Objective. The purpose of this study was to evaluate long-term histomorphometric changes in temporomandibular joints (TMJs) of rabbits after mandibular distraction osteogenesis (DO). Study Design. Twenty-six rabbits were used in this study. Two of them served as control subjects, and the remaining 24 underwent DO procedures in their left mandibular bodies. After a latency period of 5 days, 5 mm lengthening was performed at a rate of 1 mm/d. The rabbits in the experimental group were randomly divided into 4 subgroups and killed after 1, 2, 4, and 6 months. TMJs from both sides were harvested and prepared with hematoxylin and eosin stain for histomorphometric examination under an optical microscope. Results. Compared with control subjects and nondistracted sides, fibrous articular, proliferative, and hypertrophic areas were significantly increased (P < .05) in the first 2 months in distracted sides. The changes were insignificant in the fourth and sixth postoperative months. Conclusion. Unilateral mandibular distraction of 5 mm was found to be well tolerated and no degenerative changes were observed histologically in the rabbit TMJs in the long-term period. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:600-603

The relationship between changes in the expression of growth associated protein-43 and functional recovery of the injured inferior alveolar nerve following transection without repair in adult rats

Objective: The objective of this study was to analyze the changes in the expression of growth associated protein-43 (GAP-43) in trigeminal ganglions (TGs) and in the distal stumps of transected inferior alveolar nerves (IANs), and to clarify the relationship between these changes and functional recovery of the transected IAN without repair using a rat IAN axotomy model. Material and methods: Following transection, GAP-43 expression was measured at multiple time points. The functional recovery of the transected IAN was evaluated based on the compound muscle action potentials recorded from the digastric muscle. Results: GAP-43 expression in TGs was significantly higher at 2, 7, 14, 28, and 56 days following IAN transection compared to that in samples from sham-operated rats (p < 0.0005, p < 0.0005, p < 0.0005, p = 0.007, and p = 0.023, respectively). GAP-43 expression in the distal stumps of transected IANs was significantly higher at 2, 7, 14, and 28 days following IAN transection compared to that in samples taken from sham rats (p < 0.0005, p < 0.0005, p < 0.0005, and p = 0.009, respectively). GAP-43 expression in the distal stumps of transected IANs returned nearly to sham levels by day 56 following IAN transection. On days 7, 14, 28, and 56 following transection, the amplitude of the compound muscle action potential gradually increased, the latency gradually decreased, and the duration gradually increased. The amplitude, latency, and duration of the compound muscle action potentials nearly returned to sham levels on post-transection day 56. Conclusions: Time-dependent changes in the expression of GAP-43 in both TGs and distal stumps of transected IANs without repair are synchronously consistent with the regeneration and functional recovery of the transected IAN. The recovery of the amplitude, latency, and duration of the compound muscle action potentials indicates increased myelination and increased axon density of the regenerated nerve fibers. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Changes in expression of Slit1 and its receptor Robo2 in trigeminal ganglion and inferior alveolar nerve following inferior alveolar nerve axotomy in adult rats: a pilot study

The objective of this study was to analyze changes in expression pattern of Slit1 and Robo2, and to clarify the relationship between these changes and functional recovery of the axotomized inferior alveolar nerve (IAN) without repair using a rat IAN axotomy model. Slitl and Robo2 were weakly expressed in samples taken from trigeminal ganglion (TG) and IAN of sham surgery rats. In axotomized rats, expression levels increased significantly from day 2 to day 28 post-axotomy, with peaks on days 14 (Slit1) and 7 (Robo2) after axotomy (relative to sham: Slit1 in TG P < 0.0005, Slitl in IAN P = 0.003, Robo2 in TG P < 0.0005, and Robo2 in IAN P < 0.0005). Over-expressed Slitl and Robo2 in both the TG and IANs of axotomized rats did not return to sham levels during the 28-day observation period of this study. The regeneration and functional recovery of axotomized IAN was evaluated by jaw opening reflex (JOR) recorded before and after axotomy. JOR occurrence (0% on day 7, 35% on day 14, and 85% on day 28) increased gradually, and the relative threshold of electrical stimulation eliciting JOR decreased gradually (1000.0 +/- 0.0% on day 7, 854.3 +/- 132.5% on day 14, and 302.6 +/- 92.3% on day 28). On day 28 after axotomy, JOR occurrence and the relative JOR threshold had almost returned to those of sham rats. These findings suggest that Slitl and Robo2 are involved in the regeneration and functional recovery of the axotomized IAN.Namik Kemal University, Scientific Research Projects CommitteeNamik Kemal University [NKU-BAP.00.20.AR.12.10]This study was supported by Namik Kemal University, Scientific Research Projects Committee (Project No. NKU-BAP.00.20.AR.12.10)

Are Bismuth Shields Useful in Dentomaxillofacial Radiology Practice for the Protection of Eyes and Thyroid Glands from Ionizing Radiation?

Background: The eye lens and thyroid gland are sensitive to radiation and have a risk of being exposed to primary beams and scattered radiation during dental radiographic examinations

Portal vein ligation and in situ liver splitting in metastatic liver cancer

The most serious complication after major liver resection is liver failure. Depending on preoperative liver function, a future liver remnant of 25%-40% is considered sufficient to avoid postoperative liver failure. A new technique known as portal vein ligation combined with in situ splitting has been developed to obtain rapid liver hypertrophy. Herein, we present a case where we performed portal vein ligation combined with in situ splitting, A 37-year-old male patient with a diagnosis of sigmoid adenocarcinoma and liver metastasis underwent anterior resection because of an obstructing sigmoid tumor and received palliative chemotherapy. After chemotherapy, abdominal computed tomography revealed a lesion, 50 mm in diameter, localized between segments 5-8 of the liver on the bifurcation of the anteroposterior segmental branch of the right portal vein. Computed tomography volumetric assessments of the liver were performed in the preoperative period, and it was found that the remnant left liver volume was less than 25% In the first stage, portal vein ligation and in situ splitting of the liver parenchyma were performed, On the second and sixth postoperative clays, computed tomography revealed hypertrophy of the left liver lobe. On the sixth clay, a right hepatectomy was performed, Portal vein ligation combined with in situ splitting has been used by surgeons worldwide to obtain rapid and adequate liver hypertrophy. This new approach yields hope for patients with locally advanced liver tumors and may increase the number of curative resections for primary or metastatic liver tumors

In Vivo Evaluation of the Biomechanical Properties of Optic Nerve and Peripapillary Structures by Ultrasonic Shear Wave Elastography in Glaucoma

BACKGROUND: Primary open-angle glaucoma is a multifactorial serious disease characterized by progressive retinal ganglion cell death and loss of visual field. OBJECTIVES: The purposes of this study were to investigate shear wave elastography (SWE) use in the evaluation of the optic nerve (ON) and peripapillary structures, and to compare the findings between glaucomatous and control eyes. PATIENTS AND METHODS: A case-controlled study, including 21 patients with primary open-angle glaucoma and 21 age-matched control subjects, was carried out. All of the participants had comprehensive ophthalmological exams that included corneal biomechanical measurements with ocular response analyzer. In vivo evaluation of the biomechanical properties of the ON and peripapillary structures were performed with SWE in all participants. The Kolmogorov–Smirnov test was used to analyze the normal distribution of data. Differences of parameters in ophthalmologic data and stiffness values of patients with and without glaucoma were evaluated using the Mann-Whitney U test. RESULTS: There were no statistically significant differences between the glaucoma and control groups in terms of age (P > 0.05) and gender (P > 0.05). Corneal hysteresis was lower in the glaucoma group (P < 0.05). Corneal compensated intraocular pressure and Goldmann correlated intraocular pressure were higher in the glaucoma group (P < 0.0001 for both). The mean stiffness of the ON and peripapillary structures were significantly higher in glaucoma patients for each measured region (P < 0.05). CONCLUSION: The study evaluated the biomechanical properties of the ON and peripapillary structures in vivo with SWE in glaucoma. We observed stiffer ON and peripapillary tissue in glaucomatous eyes, indicating that SWE claims new perspectives in the evaluation of ON and peripapillary structures in glaucoma disease