Nazofarinks Kanserli Hastalarda Radyoterapi Sonrası MRG'de Klivustaki Medüller Intensite Değişiklikleri

Clivus is commonly involved in nasopharyngeal carcinoma (NPC) and the intensity changes in the bone marrow can persist after the radiation therapy (RT) even after the disappearance of the mucosal soft tissue mass. Furthermore the appearance of the bone marrow (BM) can also show radiation-related changes. The differentiation of residual benign signal change from a recurrent/persistent lesion may be challenging. We wanted to investigate the signal changes of the clivus in patients with nasopharyngeal carcinoma receiving RT in order to define an expected temporal evolution. Baseline and follow up MR imaging of 68 NPC patients that had undergone RT were retrospectively examined. The degree of the clival involvement (graded into 4 groups regarding its anterior-posterior extension), the BM signal changes and contrast enhancement were evaluated on baseline and 4.3 follow up studies (min/max: 2/7) per patient. The persistence of BM intensity changes were noted and correlated with the grade of initial clival involvement, the RT dose, the size of the initial mass. 46 patients who had involvement of the clivus in baseline imaging were evaluated with a mean follow up period of 46 months (max 100 months). Signal changes persisted for 31 months (max: 99 months) and clival enhancement persisted for 17.5 months (max: 99 months) for a mean period time. The signal intensity changes completely disappeared for 23.5% and enhancement of the BM completely disappeared for 68.2% patients who had clival signal changes/enhancement on first follow up MRI. 6 patients (8.8%) had recurrence in the follow up. There were correlation between the baseline clivus involvement and the resolution of signal changes (p=0.000) as well as resolution of the enhancement (p=0.000) on follow up MR studies. The resolution of the signal intensity changes/enhancement represented no correlation with the radiation therapy dose (p=0.310/0.307). In conclusion signal intensity changes and enhancement of the clivus after RT showed a large spectrum with residual signal changes even after years of remission in the majority of the patients.Nazofarinks kanseri klivusa sıklıkla invazyon gösterir ve manyetik rezonans görüntülemede (MRG) klivusta medüller intensite değişiklikleri mukozal yumuşak doku kitlesi kaybolsa bile radyoterapi sonrası persistan kalabilir. Ayrıca kemik iliği görünümü radyasyona bağlı değişiklikler de gösterir. Bu nedenle RT tedavisi sonrası kafa tabanında rezidü benign intensite değişikliğinin rezidü neoplastik süreç-rekürren lezyondan ayırmak zordur ve bu konuda uzun dönem takibi içeren çalışma bulunmamaktadır. Bu çalışmada nazofarinks kanserli hastalarda radyoterapi tedavisi sonrası klivusta medüller intensite değişikliklerinin beklenen zamansal değişimini belirlemeye yönelik olarak, radyoterapi tedavisi gören 68 nazofarinks kanserli hastanın tedavi öncesi ve tedavi sonrası kontrol MRG tetkikleri retrospektif olarak incelendi. Klivus tutulum derecesi (anterior-posterior eksende 4 gruba ayrılarak), kemik iliği intensite değişikliği ve kontrastlanma durumu her hasta için radyoterapiden önceki tetkikte ve ortalama 4,3 (min. 2; max. 7) kontrol tetkikte değerlendirildi. Persistan kemik iliği intensitedeğişiklikleri belirlendi ve klivus tutulum derecesi,radyoterapi dozu, primer tümör volümü ile karşılaştırıldı. Başlangıç tetkikinde klivus tutulumu olan 46 hastada ortalama 46 ay (max.100ay) takip ile, klivus medüller intensite değişikliklerinin 31 ay (max. 99 ay) ve kontrast tutulumunun 17,5 ay (max. 99 ay) sebat ettiği izlendi. Radyoterapi sonrası klivusta medüller intensite değişikliği ya da kontrastlanma izlenen hastalarda takip süresince intensite değişikliği %23,5 ve kontrastlanma %68,2 oranında rezolüsyon gösterdi. 6 hastada (%8,8) takipte rekürrens izlendi. Radyoterapi öncesi tetkikte klivus tutulum varlığı ile medüller intensite değişikliği ve kontrastlanma rezolüsyon süreleri arasında istatistiksel olarak anlamlı farklılık bulundu (p=0,000), ancak klivus tutulumu olan hastalarda tutulum derecesine göre farklılık saptanmadı. İntensite değişikliği ve kontrastlanma rezolüsyon süreleri ile radyoterapi dozu arasında istatistiksel korelasyon saptanmadı (p=0,310/ 0,307). Çalışma sonuçlarına göre nazofarinks kanserinde radyoterapi tedavisi sonrası klivusta izlenen medüller intensite değişiklikleri hastaların büyük kısmında remisyondan yıllar sonra bile görülebilen rezidü intensite değişikliği ve kontrastlanma şeklinde geniş bir spektrum gösterir

Flocculus Herniation into the Internal Acoustic Canal in Incomplete Partition Type I: A Case Report.

In this study, we present the first case with cerebellar herniation into the internal acoustic canal in incomplete partition type I anomaly. Cerebellar herniation into the internal acoustic canal is very rare with only a few cases reported in the literature. Although it is a rare clinical situation, cerebellar herniation into the internal acoustic canal may be seen in patients with incomplete partition type I. We presented magnetic resonance imaging findings of a 3-year-old girl with a history of meningitis, middle ear effusion, and bilateral congenital sensorineural hearing loss. Magnetic resonance imaging showed bilateral incomplete partition type I malformation and an additional flocculus herniation into the right internal acoustic canal. In the presented case, predisposition to cerebrospinal fluid leak in incomplete partition type I anomaly may be the reason for cerebellar herniation into internal acoustic canal. Also, possible increased intracranial pressure due to meningitis may be a contributing factor

Use of complementary and alternative medicine in patients with chronic viral hepatitis in Turkey

WOS: 000514023100014PubMed: 31987221Introduction: The global use of complementary and alternative medicine (CAM) is growing. The purpose of this study was to determine the prevalence of CAM use in patients in Turkey with CVH, the types of therapy, and patients' sociodemographic characteristics. Methods: The study was designed as a questionnaire-based, cross-sectional analysis. An infectious diseases outpatient follow-up questionnaire was administered to patients at face-to-face interviews. The data obtained were analyzed using SPSS 17 software. Results: This study included 588 patients, of whom 27% used CAM. No differences in sociodemographic characteristics were determined between patients using CAM and those not using it. Herbal methods were used by 63.6% of patients and cupping techniques by 25.4%. Education level was significantly correlated with herbal methods (p = 0.043). CAM use also increased in line with disease duration (p < 0.05). No difference in CAM use was determined between CHB patients using oral antiviral therapy and those not using it (p = 0.162). Conclusion: CAM use, particularly herbal products, is prevalent among Turkish adults with CVH. In case of use of herbal products in chronic viral hepatitis patients, toxicity and liver failure may develop as a result of herbal product-drug interactions. Physicians in the field of hepatology should, therefore, be aware of potential toxicity of CAM, especially in patients with chronic hepatitis liver diseases

Role of serostatus in pediatric neuromyelitis optica spectrum disorders: A nationwide multicentric study

Background: Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory disorders of the central nervous system (CNS) mostly presenting as optic neuritis and acute myelitis. NMOSD can be associated with seropositivity for aquaporin 4 antibody (AQP4 IgG), myelin oligodendrocyte glycoprotein antibody (MOG IgG), or can be seronegative for both. In this study, we retrospectively examined our seropositive and seronegative pediatric NMOSD patients. Method: Data were collected from all participating centres nationwide. Patients diagnosed with NMOSD were divided into three subgroups according to serology: AQP4 IgG NMOSD, MOG IgG NMOSD, and double seronegative (DN) NMOSD. Patients with at least six months of follow-up were compared statistically. Results: The study included 45 patients, 29 female and 16 male (ratio:1.8), mean age 15.16 ± 4.93 (range 5.5–27) years. Age at onset, clinical manifestations, and cerebrospinal fluid findings were similar between AQP4 IgG NMOSD (n = 17), MOG IgG NMOSD (n = 10), and DN NMOSD (n = 18) groups. A polyphasic course was more frequent in the AQP4 IgG and MOG IgG NMOSD groups than DN NMOSD (p = 0.007). The annualized relapse rate and rate of disability were similar between groups. Most common types of disability were related to optic pathway and spinal cord involvement. Rituximab in AQP4 IgG NMOSD, intravenous immunoglobulin in MOG IgG NMOSD, and azathioprine in DN NMOSD were usually preferred for maintenance treatment. Conclusion: In our series with a considerable number of double seronegatives, the three major serological groups of NMOSD were indistinguishable based on clinical and laboratory findings at initial presentation. Their outcome is similar in terms of disability, but seropositive patients should be more closely followed-up for relapses