Recurrent Chest Pain, as a Presenting Sign of Ovarian Endometrioma

Chest pain is a rare sign of thoracal endometriosis associated with endometrioma of the tubo-ovarian endometrioma. We report the case periodic episodes of chest pain concurrent with menstruation in a 35-year-old female, in which ovarian endometrioma was diagnosed and left-sided oophorectomy was performed. After surgery, patient underwent medical treatment which included a Gn-RH agonist and a combined oral contraceptive. In the follow-up period, there was no evidence of chest pain

Comparative morphological differences between umbilical cords from chronic hypertensive and preeclamptic pregnancies.

To compare morphological changes in the umbilical cords from chronic hypertensive and preeclamptic patients having normal or pathological umbilical artery Doppler ultrasonographic results. Umbilical cords from 34 normotensive, 31 chronic hypertensive and 70 preeclamptic women with normal and abnormal Doppler flow velocity waveforms (FVW) at 35-40 gestational weeks were studied. Morphological changes in the umbilical cords were examined on formalin-fixed, paraffin-embedded sections. The total umbilical cord area, total vessel area, and wall thickness of umbilical vessels were measured in systematic random samples using unbiased stereology methods. An ANOVA test was used for statistical analysis. In the chronic hypertensive and preeclamptic groups with normal Doppler FVW, the thickness of the umbilical cord vessels remained nearly constant, whereas both the total area and the lumen area were reduced. These changes correlate with the histopathological findings, suggesting a mainly vasoconstrictive effect. By contrast, analysis of the preeclamptic group with pathologic Doppler FVW showed a comparable reduction of all parameters of the umbilical cord. Histopathological findings were related to smaller, contracted smooth muscle cells of the vessel wall, which is suggestive of a predominant hypoplastic mechanism. As a result of reduced uteroplacental perfusion, fetal hypoxia and intrauterine growth retardation become unavoidable in preeclampsia. The histopathological changes in the umbilical cord between the chronic hypertensive and preeclamptic patients depend on the Doppler results. In conclusion, the umbilical artery Doppler FVW indices provide good values for predicting intrauterine growth retardation in preeclamptic patients.</p

Splanchnic vein thrombosis following renal transplantation: a case report

BACKGROUND: Recurrent episodes of venous thrombosis have been closely correlated with JAK2 V617F mutation. Upto date, JAK2 gene mutation has not been defined as a prothrombic risk factor in renal transplant recipients. Herein; we present a case of portosplenic vein thrombosis in a primary renal transplant recipient with JAK2 V617F mutation who had no history of prior venous thromboembolism or thrombophilia. CASE PRESENTATION: A 59 year old female caucasian patient with primary kidney transplant admitted with vague abdominal pain at left upper quadrant. Abdominal doppler ultrasound and magnetic resonance imaging angiography demonstrated splanchnic vein thrombosis (SVT). The final diagnosis was SVT due to MPD (essential thrombocytosis, ET) with JAK2 V617F mutation. After 3 months of treatment with warfarin (≥5 mg/day, to keep target INR values of 1.9-2.5), control MRI angiography and doppler USG demonstrated partial (>%50) resolution of thrombosis with recanalization of hepatopedal venous flow. The patient is still on the same treatment protocol without any complication. CONCLUSION: JAK2 V617F mutation analysis should be a routine procedure in the diagnosis and treatment of kidney transplant patients with thrombosis in uncommon sites

Applicability of fetal renal artery Doppler values in determining pregnancy outcome and type of delivery in idiopathic oligohydramnios and polyhydramnios pregnancies

Aims: To investigate the relationship between fetal renal artery Doppler results and pregnancy outcomes in patients with idiopathic abnormal amniotic fluid indices. Material and method: A total of 110 patients without signs of fetal distress were included in the study: 31 idiopathic oligohydramnios and 29 idiopathic polyhydramnios pregnancies (study group) and 50 normal pregnancies (controls). Doppler investigation of the umbilical artery (UA), middle cerebral artery (MCA), fetal descendant thoracic aorta (DTA) and fetal renal artery (RA) was performed in all patients. Fetal RA resistive index (RI) and pulsatile index (PI) values were measured. Values pertaining to type of birth, newborn weight and APGAR scores were compared. Results: Average patient age, gravidity and week of pregnancy were 25±4, 1.6, and 37.4±1, respectively. There were no statistically significant differences between the groups as far as UA S/D, MCA S/D, DTA S/D, DTA RI, DTA PI, and RA S/D measurements were concerned. However, in the oligohydramnios group RA RI and RA PI values were significantly higher than the other two groups. Birth weight in the polyhydramnios group and cesarean section rate due to fetal distress in the oligohydramnios group were significantly higher. Conclusions: In the oligohydramnios group, without affecting fetal distress parameters, Doppler USG evaluation identified an increase in the RA resistance. Also in that group, cesarean rate due to fetal distress during labor was significantly higher than in the remaining two groups. Due to the predictive potential of values of fetal renal artery Doppler of fetal outcome further large sample-sized studies on the subject ought to be carried out

The Role of Fetal MRI-based Texture Analysis in Differentiating Congenital Pulmonary Airway Malformation and Pulmonary Sequestration

Aim: The purpose of our study was to evaluate the diagnostic performance of fetal magnetic resonance imaging (MRI)-based texture analysis (TA) to differentiate the two most common lung malformations, congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS). Materials and Methods: This retrospective single-center study included 24 patients with CPAM and 8 patients with PS who had a fetal MRI examination between January 2015 and December 2020. T2-weighted coronal images were used for TA. One reader designated the malformation borders and drew a region-of-interest for TA. The differences in values of the texture features between the groups were assessed and receiver operating characteristic curves were calculated for each statistically significant feature. P-value<0.05 was considered statistically significant. Results: Forty-eight texture features were calculated for each malformation. Twenty features on T2-weighted images were significantly different between the CPAMSs and PSs. Among these, short-run high gray-level emphasis and long-run emphasis, which are gray-level run length matrix features parameters, had the largest area under the curves: 0.956 (sensitivity 87%, specificity 95%) and 0.943 (sensitivity 87%, specificity 85%), respectively. Conclusion: Our results suggest that fetal MRI-based TA may be used to distinguish CPAMs from PSs in fetuses with uncertain pulmonary findings prior to birth

Melanotic Schwannomas Are Rarely Seen Pigmented Tumors with Unpredictable Prognosis and Challenging Diagnosis

Melanotic Schwannoma (MS) is rarely seen and potentially malignant neoplasm that is categorized as a variant of Schwannoma. MS most frequently involves intracranial structures followed by posterior nerve roots in the spinal canal. Approximately 50% of the cases with MS have psammomatous calcifications and this type of MS is related to Carney complex with autosomal dominant inheritance. Most cases of MS are benign, though 10% of them are malignant with metastatic potential. MS mimics melanoma and the differential diagnosis should be made excluding other melanin producing neoplasms especially melanoma. Case 1. A 42-year-old hypertensive male presented for checkup. He had a well-defined extraspinal oval lesion measuring 3.5 × 2.5 cm near right adrenal. Case 2. A 22-year-old female presented with neurofibromatosis-2, bilateral acoustic schwannomas and café au lait lesions on sacrococcygeal region. She had an intradural extramedullary lesion measuring 6.1 × 2.0 cm at L1-2 level. MS is a rare neoplasm composed of Schwann cells and melanin pigment. These tumors are usually benign but they may become aggressive. The biologic behavior of MS is difficult to predict; the patients have to be followed up for a longer period due to its malignant potential

Evaluation of the relationship between cranial magnetic resonance imaging findings and clinical status in children with cerebral palsy

Background/aim: The objective of this study was to evaluate the relationship between cranial magnetic resonance imaging (MRI) findings and clinical features in cerebral palsy (CP). Materials and methods: Children aged 3 to 18 years, who were followed with the diagnosis of CP between January 2012 and September 2015, were included. The type of CP was classified using the European Cerebral Palsy Monitoring Group's classification system and then, patients were divided into two groups as spastic or nonspastic groups. The Gross Motor Function Classification System (GMFCS) was used to determine the level of mobility. According to the GMFCS, levels 1, 2, and 3 were grouped as mobile, and levels 4 and 5 were grouped as immobile. Cranial MRI findings were reevaluated by a voluntarily radiologist and grouped as periventricular leukomalacia (PVL) (grades 1, 2, and 3), cerebral atrophy, migration anomaly, cerebellar involvement, basal ganglion involvement, and normal MRI findings. Results: Sixty-two patients were enrolled. The rate of mobile patients did not differ between the spastic and nonspastic groups. The incidence of PVL was significantly higher in cases of prematurity and spastic CP (p < 0.05). The rate of mobilization was significantly lower and the rate of epilepsy was significantly higher in patients with PVL. Immobile patients were more common among cases of grade 3 PVL (p < 0.05). Conclusion: The most common cranial MRI pathology was PVL, and the presence of PVL and its grade might help clinically assess the patient's CP type and level of mobilization. While pathology was observed mostly in cranial MRI in cases of CP with similar clinical features, the fact that cranial MRI was completely normal for 14.5% of the cases suggests that there may be some pathologies that we could not identify with today's imaging technology