A rare case of schwannoma arising from a diverticulum in the first portion of duodenum

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Assessment of Ten-Year-Long Results of Kidney Biopsies Performed on Children in the Thrace Region of Turkey

Background: Many children with kidney diseases can be diagnosed and treated without a biopsy. However, biopsy is a valuable method for the diagnostic and prognostic evaluation of children with kidney diseases. Aims: To evaluate the clinical and pathological profiles of the kidney biopsies in our department to provide epidemiological data for clinical practice. Study Design: Retrospective cross-sectional study. Methods: Kidney biopsies and patient's charts in pediatric patients performed between May 2005 and February 2015 at the Pediatric Nephrology Department, Trakya University School of Medicine were assessed retrospectively. Results: A total of 100 patients were examined. Their mean age was 9.62±4.26 years (range: 1-17 years); 54% of the patients were girls and 46% were boys. The most frequent indication for kidney biopsy was nephrotic syndrome (33%). The most common kidney disease was primary glomerulonephritis, which was observed in 65% of cases. IgA nephropathy (24%) was the most frequently observed subtype in primary glomerulonephritis groups. Secondary glomerulonephritis was diagnosed in 35% of cases. Systemic lupus erythematosus (51%) was the most frequently observed subtype in the secondary glomerulonephritis groups. Conclusion: IgA nephropathy and systemic lupus erythematosus were the most frequent primary and secondary glomerulonephritis in our region among children, respectively

Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Background:It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complica-tions during percutaneous abdominal interventions. Aims:The aim of this study was to map the inferior epigastric ves-sels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. Study Design: Retrospective comparative study.Methods:Coronal reconstructed two-detector computed tomogra-phy images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and dis-tal). Vein and artery arrangements were documented.Results:The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides were 4.01 and 4.47 cm at the umbilical level, 3.81 and 4.26 cm at the midlevel, and 5.62 and 5.51 cm at the origin level. On both sides, measurement differences between the three levels were highlysignificant (p<0.05). In addition, a total of 56 IEA bifurcations were depicted in all 200 patients. Thirteen of the 56 bifurcations occurredonly on the right side, 11 only on the left side, and 32 on both sides.Conclusion:It is important to be attentive to the IEA's course, at different midline levels, when attempting percutaneous interventions via an abdominal approach

Küçük hücreli akciğer kanserinde yıkıcı bir durum: Ektopik cushing sendromu

Ektopik adrenokortikotop (ACTH) salınmasına bağlı Cushing sendromu, küçük hücreli akciğer kanserli hastalarda diğer birçok paraneoplastik sendromlara göre daha sık görülür. Bu hastalarda hücresel bağışıklık sisteminin baskılanması hem hekimler hem de hastalar için önemli bir sorundur. Ek olarak kemoterapi, bu hastalarda şiddetli ve daha yüksek oranda hematolojik toksisiteye neden olmaktadır. Biz ektopik ACTH salınması ile ilişkili Cushing sendromuna bağlı humoral ve hücresel bağışıklık sistemi baskılanmış çok kötü seyirli bir küçük hücreli akciğer vakası sunduk. Ayrıca, bu özel vaka ve literatür ışığında Cushing sendrom olan küçük hücreli akciğerli hastalar için tedavi stratejileri önerdik.Ectopic secretion of adrenocorticotropic hormone (ACTH) related Cushing's syndrome (CS) is more frequently observed than many other paraneoplastic syndromes in patients with small cell lung cancer. Suppression of the cellular immune system in these patients is severe problem for both patients and physicians. In addition, the chemotherapy has been caused to severity and higher rate of hematological toxicity. We present a case of small cell lung cancer having a very poor prognosis, with a compressed humoral and cellular immune system due to an ectopic secretion of ACTH related CS. We report a rare case of combined immunosuppression in a case with small cell lung cancer in this paper. In addition, in the light of this special case and literature, we suggest treatment strategies for small cell lung cancer patients with CS

Diffusion Weighted Magnetic Resonance Imaging for the Characterization of Solitary Pulmonary Lesions

Background: We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging.Aims: To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pul-monary lesions.Study Design: Randomized prospective study.Methods: This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 ma-lignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm2). Apparent diffusion coeffi-cients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the le-sions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups.Results: On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm2. In contrast, on T2 weighted images, it was seen that the distinction of malignant lesions from benign lesions was not statistically significant. The ADCs of the malignant lesions were significantly lower than those of benign lesions (mean ADC was 2.02×10-3 mm2/s for malignant lesions, and 1.195×10-3±0.3 mm2/s for benign lesions). Setting the cut-off value at 1.5×10-3, ADC had a sensitivity of 86.7% and a specificity of 88.9% for the differentiation of benign lesions from malignant lesions.Conclusion: DWI may aid in the differential diagnosis of solitary pulmonary lesions. (ClinicalTrials.gov Iden-tifier: NCT02482181

Evaluation of pancreatic malign tumours with mangafodipir trisodium

Amaç: Organ spesifik ajan olan mangafodipir trisodyum (Mn-DPDP) kullanılarak yapılan manyetik rezonans görüntülemenin pankreas malign kitlelerinin incelenmesinde tanısal etkinliğini incelemek. Hastalar ve Yöntemler: Abdominal ultrasonografi ve bilgisayarlı tomografi bulguları ile pankreas tümörü düşünülen 17 hastanın (7 kadın, 10 erkek; ort. yaş 63.2±12; dağılım 36-80) manyetik rezonans görüntüleri, T1A SE, yağ baskılı T1A SE ve T1A GRE sekanslarının kullanımı ile sinyal-gürültü (S/N) ve kontrast-gürültü (C/N) oranları açısından Mn-DPDP uygulaması öncesi ve sonrası incelendi. Bulgular: Kontrast öncesi ve sonrası incelemelerde normal pankreasın S/N oranlarında artış T1A SE sekansta ortalama %22.81, yağ baskılı T1A SE sekansında %32.88 ve T1A GRE sekansında %20 olarak bulundu. Normal pankreas dokusu ve tümör kitlesi sinyal intensite değerlerinden hesaplanan C/N oranında ise yüzde artış T1A SE sekansı için ortalama %58.69, yağ baskılı T1A SE sekansta %125.41 ve T1A GRE sekansta %62.06 olarak saptandı. Ayrıca uygulanan sinyal intensite ölçümlerine göre her üç sekansta elde edilen kontrast öncesi ve sonrası C/N oranlarındaki artış istatistiksel olarak anlamlı idi (paired Student t testi p<0.0001). Sonuç: Kontrast madde olarak Mn-DPDP'nin kullanımı ile C/N oranlarındaki değişim pankreasın malign kitlelerinin incelenmesinde tanıya katkı sağlayabilir.Objectives: Our study aimed to assess the diagnostic capabilities of mangafodipir trisodium (Mn-DPDP)- enhanced magnetic resonance imaging for the evaluation of pancreatic malign mass. Patients and Methods: Magnetic resonance images of 17 patients (7 females, 10 males; mean age 63.2&plusmn;12 years; range 36 to 80 years) suspected of pancreatic tumor by abdominal ultrasonography and computed tomography findings, were examined in terms of signal to noise (S/N) and contrast to noise (C/N) ratios before and after administration of Mn-DPDP using T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences. Results: Before and after administration of Mn-DPDP, the increase in S/N ratios of normal pancreatic parenchyma were found as 22.81%, 32.88% and 20% in T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences, respectively. The increase in C/N ratios obtained from signal intensity values of normal pancreatic tissue and tumor were found as 58.69%, 125.41% and 62.06% in T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences, respectively. Furthermore, in all sequences, before and after contrast medium administration, the increase of C/N ratios were found statistically significant (paired Student's t test, p&lt;0.0001). Conclusion: The differences of C/N ratio using Mn-DPDP as a contrast agent may contribute to the diagnosis of pancreatic malign masses

Superparamagnetic Iron Oxide Enhanced Magnetic Resonance Imaging in the Detection of Malignant Liver Lesions

Objective: To determine the value of superparamagnetic iron oxide (SPIO)-enhanced MR imaging in malignant liver lesions.Materials and Methods: Twenty patients with various hepatic masses or metastases were investigated with 1 tesla MR. T1-weighted FLASH and double- echo TSE T2-weighted sequences were applied before and after contrast injection. “Defining statistics” were prepared according to pre and postcontrast signal intensity measurements. Results: In this study there were 11 patients with metastases, 4 patients with hemangioma, 4 patients with HCC and one patient with a hemangioma and a metastasis at the same time. In cases wheret we found only hemangiomas, in all sequences, S/N ratios (p=0.043) and T2-weighted double-echo TSE with long TE SI change (p=0.043) were significant. While in the hemangiomas in T2-weighted double-echo TSE with long TE there is an decrease in the C/N ratios; in cases with metastasis and HCC, compared to other sequences significant increase in C/N ratio in T2-weighted double-echo TSE with short TE sequences was detected.Conclusion: SPIO-enhanced MR imaging can be used as a non-invasive radiologic technique for the detection focal liver lesions, to determine the number of lesions and also has a value in differentiating the benign lesions (especially hemangiomas) from primary tumors or metastatic malignant lesions

Hypertrophic Pyloric Stenosis Mr Findings

Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting young infants, in which the antropyloric portion of the stomach becomes abnormally thickened and manifests as obstruction to gastric emptying. The clinical diagnosis hinges on palpation of the thickened pylorus, or &apos;olive.&apos; Abdominal palpation is accurate but not always successful, in such cases, radiologic examinations including US or MRI can be performed. US is the first choice of imaging modality. Unfortunately, in case of difficulty by the sonographic diagnosis of IHPS such as overlying bowel gas, MRI could be useful for the diagnosis

CT-angiographic demonstration of hepatic collateral pathways due to superior vena cava obstruction in Behcet disease

Behcet disease (BD) is a chronic multisystemic inflammatory disorder, mainly characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. Large vein thrombosis in BD is unusual; when present, it is most frequently seen in the inferior or superior vena cava (SVC). The authors describe an unusual hepatic pseudolesion caused by abnormal focal enhancement through collateral pathways to the liver in two BD patients with SVC occlusion on three-dimensional multi-detector computed tomography, using volume rendering and maximum intensity projection techniques. BD should be suspected in patients presenting a focal increased hepatic enhancement area with collaterals caused by occlusion of the SVC without evidence of a hypercoagulable state or malignant mediastinal or thoracic venous inlet obstruction

Three-dimensional volume rendering imaging in detection of bone fractures

We aimed to evaluate the contribution of 3D volume rendering (VR) imaging findings on bone fractures. Routine CT examinations and 3D VR imaging were performed on 31 patients with bone fractures. MIP and VR images having optimal resolution in all patients were obtained using 3D reconstructions on work-station. Bone fractures and extension, bone fragment, and soft tissue changes were evaluated. Distribution of bone fractures were as follows; clavicula (n=4), radius (n=8), acetabulum (n=3), shoulder (n=4), tibia (n=6), carpal bone (n=2), sacrum (n=1) and femur (n=3). Complex fractures were seen one in scapula and 2 in pelvic region. Complex injuries, bone fragments, extension of fractures were better demonstrated with volume-rendered images. We conclude that 3D VR imaging is valuable method in detecting bone fractures and superior to other radiologic modalities