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We report ultrasound-guided direct percutaneous injection of n-butyl cyanoacrylate for preoperative embolization of carotid body tumor in a 50-year-old patient. Angiographic road map assistance was used for protection of parent arteries during the injection. After embolization, complete devascularization of the tumor was achieved without complications. The tumor was removed surgically with minimal blood loss. This procedure is effective and promising for preoperative embolization of carotid body tumors. [ABSTRACT FROM AUTHOR]

Objective. Ectopic posterior pituitary gland (EPP) is usually characterized by an abnormal pituitary stalk and hypoplasia of the anterior hypophysis. The genetic mechanisms involved in the development of EPP remain uncertain. The aim of this study is to determine whether mutations in the three genes, PROP-1, LHX2, and POU1F1, are associated with the risk for and the characteristics of EPP. Methods. In the Endocrinology Outpatient Clinic of "Dr. Behcet Uz" Children's Hospital, 27 patients with EPP were submitted to sequencing analyses of the PROP-1, LHX2, and POU1F1 genes. Results. Growth hormone, thyrotropin, corticotropin, gonadotropin, and vasopressin deficiency were observed in 22 (81.5%), 23 (85.2%), 17 (63%), 14 (51.9%), and two (7.4%) patients. Thirteen patients (48.1%) presented with hyperprolactinemia. Fourteen patients (51%) had a history of birth dystocia, and 12 cases (42.1%) had a history of breech presentation. Central nervous system abnormalities included five cases with corpus callosum agenesis, one case with schizencephaly, and one case with Chiari type 1 malformation. We identified a homozygous p.S109* mutation in exon 2 in one male patient with EPP and two different PROP1 gene polymorphisms (A142T or c.109+3 G>A polymorphism) in thirteen patients. Conclusions. Our results suggest that PROP1 gene abnormalities might explain the genetic mechanisms involved in the development of EPP. [ABSTRACT FROM AUTHOR]

Unlabelled: Many immunologic and inflammatory mechanisms play a role in asthma etiology. The aim of this study was to investigate the susceptibility of asthma patients in the Turkish population with demonstrating genes for polymorphisms in TIM1, TSLP and IL18R1. All of the genomic DNA samples were isolated from blood samples according to a standard salting-out protocol. DNA samples were stored at -20°C until the genotype analysis was performed. rs3806933 (TSLP -847 C > T) and TIM1 -416G > C were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The rs3806933 (TSLP -847 C > T) was genotyped by PCR using our new primers and HphI restriction enzyme digestion. rs2287033 (IL18R1 c. 1270+150 A > G), rs3213733 (IL18R1 c. 626-196 G > T), and rs3771166 (IL18R1- c. 302+1694 C > T) were genotyped using SYBR green dye based real time PCR assay., Results: The allele frequencies of 5 SNPs in TSLP, TIM-1, and IL18R1 genes were determined in 139 asthmatic patients and 126 healthy controls of in Turkish population. The investigated SNPs are as follows; rs3806933 (TSLP -847 C > T), TIM1 -416G > C, rs2287033 (IL18R1 c. 1270+150 A > G), rs3213733 (IL18R1 c. 626-196 G > T), and rs3771166 (IL18R1- c. 302+1694 C > T). Results suggest that IL18R1 c. 626-196 G > T (rs3213733) and TIM1 -416G > C are significantly associated with asthma in patients in Turkish population. Patients with AA genotypes of rs2287033 (IL18R1 c. 1270+150 A > G), have significantly less total serum IgE levels when compared with patients having GG or GA genotypes (p < 0.012; 381.77±239.46 vs 557.52±549.96, respectively)., Conclusion: This study showed that IL18R1 c. 626 -196 G > T (rs3213733) and TIM1 -416G > C are significantly associated with asthma patients in Turkish population.

Agenesis of the sphenoid sinuses is a very rarely encountered anatomic variation. Findings on magnetic resonance imaging can mislead the radiologist and clinician. Therefore, the gold standard for diagnosis is computed tomography (CT) of the paranasal sinuses. We present the case of a 28-year-old man who was admitted to our hospital with a 3-month history of headache. CT of the paranasal sinuses revealed isolated bilateral sphenoid sinus agenesis.

Aim: To evaluate the role of perioperative freezing in the management of surgical procedures in patients with malignant renal masses., Materials and Methods: The study group consisted of 17 patients diagnosed with renal masses who underwent nephron-sparing surgery. The group included 5 females and 12 males aged from 44 to 68 years (mean = 54.6). The mean mass size was 5.5 cm. Mass locations were as follows: 9 were in the lower pole, 4 were in the mid-pole, and 6 were in the upper pole. Perioperative freezing was not carried out. The patients were followed-up in a period ranging from 3 months to 7 years., Results: Tumor pathology was reported as renal cell carcinoma in all cases, and surgical margins were negative in all of them. One patient died after 1 year because of tumor metastasis. In another patient, the tumor reoccurred in the same kidney and a radical nephrectomy was performed. Other patients were followed without recurrence., Conclusion: Imaging of the renal vascular system and freezing during surgery is not necessary for nephron-sparing surgery for renal cell carcinoma; however, we should be careful in terms of capsule invasion because of tumor recurrence.

Single-nucleotide polymorphism (SNP) genotyping is widely used in genetic association studies to characterize genetic factors underlying inherited traits. Despite many recent advances in high-throughput SNP genotyping, inexpensive and flexible methods with reasonable throughput levels are still needed. Real-time PCR methods for discovering and genotyping SNPs are becoming increasingly important in various fields of biology. In this study, we introduce a new, single-tube strategy that combines the tetra-primer ARMS PCR assay, SYBR Green I-based real-time PCR, and melting-point analysis with primer design strategies to detect the SNP of interest. This assay, T-Plex real-time PCR, is based on the T(m) discrimination of the amplified allele-specific amplicons in a single tube. The specificity, sensitivity, and robustness of the assay were evaluated for common mutations in the FV, PII, MTHFR, and FGFR3 genes. We believe that T-Plex real-time PCR would be a useful alternative for either individual genotyping requests or large epidemiological studies., (Copyright © 2013 Elsevier Inc. All rights reserved.)

A 21-year-old female patient admitted to the emergency department complaining of left side pain. Hypovolemic shock, which was probably caused by retroperitoneal bleeding from left sided renal angiomyolipoma, was developed. Abdominal computed tomography showed multiple fat containing lesions in different, regions including right bladder wall, lower pole of left kidney, and right kidney. Some lesions compatible with tuberous sclerosis such as angiofibromas, Shagreen patches, myocardial, and brain hamartomas were also detected. Bladder wall mass showing intra- and extravesical extensions was seen at exploration. We removed the tumor completely preserving bladder trigone. Angiomyolipoma located at lower pole of left kidney was also removed. Diagnosis of bladder angiomyolipoma was confirmed by the immunohistochemical examination. Recurrent or residual mass was not detected at the three-months-follow-up. We report the first case of bladder angiomyolipoma confirmed by histopathologically as a tuberous sclerosis.

Purpose: To compare the results of microsurgical and naked eye varicocelectomy in patients with grade 3 varicocele., Materials and Methods: This study was conducted on 84 patients with grade 3 varicocele, between 2007 and 2009. Patients were randomized into two groups, equal in number. Thereafter, microsurgical varicocelectomy was performed in the first group, while the other group underwent naked eye varicocelectomy. Groups were compared in terms of operation duration, number of ligated internal and external spermatic veins, early and late postoperative complications, and postoperative color Doppler ultrasonography findings. Parametric and nonparametric values were compared using Student's t test and Chi-Square test, respectively., Results: The mean duration of surgery was 19 ± 2.3 minutes (range, 12 to 25 minutes) in the naked eye surgery group and 43 ± 3.9 minutes (range, 25 to 75 minutes) in the microsurgery group (P = .008). The number of ligated internal and external spermatic veins, the incidence of early and late postoperative complications, and color Doppler ultrasonography findings were not significantly different between the two groups (P = .12, P = .09, P = .17, and P = .22, respectively)., Conclusion: In patients with grade 3 varicocele, microsurgery and naked eye surgical methods proved similar results in terms of success and complications. Because the operation time of the classical varicocelectomy is significantly shorter, it may be preferred in this subset of patients.

The single nucleotide polymorphism (SNP) genotyping is currently considered as a particularly valuable tool for the diagnosis of different pathologies. For this reason, over the past several years a great deal of effort has been devoted to developing accurate, rapid, and cost-effective technologies for SNP analysis. Although a large number of distinct approaches has been reported each laboratory use one of the published methods based on their technical and economical capacity. This article presents an application of an in-house assay, tetra-primer ARMS PCR assay, and its application in SNP genotyping. We have shown that this assay could be more advantageous when compared with PCR-RFLP, real time PCR, and DNA sequencing. We have shown that the assay is successful in genotyping using archived paraffin-embedded tissues, heparinated samples and amniotic fluids with meconium. These low-costed (3$/reaction) assays could be completed within 3-4 h after specimen receipt allowing for a reasonable turn-around time in the laboratory. Since tetra-primer ARMS PCR assay does not require any special equipment, the assay could be set up in most clinical diagnostic laboratories., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Spinal muscular atrophy (SMA), the leading genetic cause of death in childhood, is an autosomal recessive neuromuscular disorder characterized by progressive muscle weakness, associated with deletions of the survival motor neuron 1 (SMN1) gene. Approximately 94% of SMA patients carry homologous deletions of SMN1 exon(s) 7 (and 8). Because of the high incidence and severity of the disease, precise detection and quantification of SMN1 and SMN2 gene copy numbers is essential for diagnosis and genetic counseling. We have developed a reliable single-tube tetra-primer PCR assay to simultaneously detect both the SMN1 and SMN2 exon 7 deletion using the advantage of C/T difference at nucleotide position of 840 in exon 7. The assay has been optimized and tested in 48 healthy controls, 20 known patients with SMA, 12 carriers (one SMN1 copy), and 8 amniotic fluids suspected of having SMA for whom we had determined the SMN1/SMN2 deletion by an additional PCR-RFLP method. We have observed complete concordance between methods. Our tetra-primer PCR assay is sensitive, low-cost, and easy to use method for simultaneous detection of both SMN1 and SMN2 deletion, which could be used even in "low-tech" laboratories.

Purpose: The aim of this study was cerebrospinal flow quantification in the cerebral aqueduct using cine phase-contrast magnetic resonance imaging (MRI) technique in both sexes and five different age groups to provide normative data., Materials and Methods: Sixty subjects with no cerebral pathology were included in this study. Subjects were divided into five age groups: < or =14 years, 15-24 years, 25-34 years, 35-44 years, and > or =45 years. Phase, rephase, and magnitude images were acquired by 1.5 T MR unit at the level of cerebral aqueduct with spoiled gradient echo through-plane, which is a cine phase-contrast sequence. At this level, peak flow velocity (cm/s), average flow rate (cm/ s), average flow (L/min), volumes in cranial and caudal directions (mL), and net volumes (mL) were studied., Results: There was a statistically significant difference in peak flow between the age group of < or =14 years and the older age groups. There were no statistically significant differences in average velocity, cranial and caudal volume, net volume, and average flow parameters among different age groups. Statistically significant differences were not detected in flow parameters between sexes., Conclusion: When using cine-phase contrast MRI in the cerebral aqueduct, only the peak velocity showed a statistically significant difference between age groups; it was higher in subjects aged < or =14 years than those in older age groups. When performing age-dependent clinical studies including adolescents, this should be taken into consideration.

Background: Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated., Materials and Methods: A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed., Results: During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm2 preoperatively and 0.21 cm2 postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure., Conclusions: In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.

Achondroplasia is the most common form of dwarfism and has an incidence of approximately 1/7500. In more than 98% of cases, the disease is associated with a G to A or G to C substitution at nucleotide position 1138 (p.G380R) of the fibroblast growth factor receptor 3 (FGFR3) gene. We have developed a sensitive single tube tetra-primer PCR assay to detect both the c.1138G>A and c.1138G>C mutations and can successfully distinguish DNA samples that are homozygous and heterozygous for the c.1138G>A mutation. Titration studies showed that the assay could reliably detect one copy of the mutant allele in a mix of 100 wild-type alleles. The assay has been tested in 50 healthy controls, 3 known patients with achondroplasia, and 5 amniotic fluids suspected of having achondroplasia and for whom we had previously determined the genotypes for the c.1138G>A mutation by PCR-RFLP. We have observed complete concordance between methods. Our tetra-primer PCR assay is sensitive, low-cost, and easy to use method for FGFR3 p.G380R genotyping, which could be used even in "low-tech" laboratories.

A 14-year-old female with autoimmune hemolytic anemia (AIHA) developed an acute hemolytic crisis with acute renal failure under conventional treatment with corticosteroids. Because of the life-threatening situation, we decided to start pulse dose methylprednisolone and also hemodialysis with a femoral catheter placement was performed. Fifteen days after initiating of dialysis subfebrile fever was developed, followed within 2 days with a left hemiparesis. Brain magnetic resonance imaging (MRI) revealed multiple intracerebral abscesses. The clinical picture worsened and the patient died before scheduled surgery for the abscesses., (2007 Wiley-Liss, Inc)

Recently, an acquired somatic point mutation (p.V617F) in a highly conserved residue of the pseudokinase domain of the JAK2 tyrosine kinase was shown to be associated with myeloproliferative disorders. Because of the clinical importance of this mutation in diagnosing myeloproliferative disorders and its relevance for disease progression, we have developed a tetra-primer polymerase chain reaction (PCR) assay to detect JAK2 p.V617F. Titration studies showed that the assay could reliably detect one copy of the mutant allele in a mix of 50 wild-type alleles suggesting that the lower detection limit of this assay is estimated to be 2%. This study demonstrates that genotyping and quantifying of the JAK2 V617F mutation can be performed by tetra-primer PCR using both freshly isolated and formalin-fixed tissues. Our tetra-primer PCR assay is sensitive, low-cost, and easy to use method for the detection of JAK2 p.V617F, which could be used even in low-tech laboratories.

We aimed to determine the degree and extent of parenchymal abnormalities on pulmo-CT in patients with emphysema. The study group consisted of 29 patients (18 male, 11 female; mean age 57.9+/-13). The diagnosis was based on clinical symptoms, pulmonary function tests (PFT) values, and chest CT findings. All of the patients CT scans were obtained during suspended deep inspiration from the apices to the costophrenic angles. The mean lung attenuation (MLD) and parenchymal abnormalities related to emphysema were quantitatively calculated with tables, histograms and graphics at the whole lung. The lung density measurements revealed a mean density of -898.48+/-51.37 HU in patients with emphysema and -825.1+/-25.5 HU in control group. In addition, mean percentage of subthreshold attenuation values was found as 12.03+/-15.75 and 1.07+/-0.83 in patients with emphysema and control group, respectively. Compared with control group, the patients with emphysema had a significantly lower inspiratory MLD (p<0.05). Additionally, statistically significant correlations were seen between the MLD and percentage of subthreshold values (r=0.44, p<0.05). In contrast, there was poor correlation between PFT measurements and the subthreshold values. In conclusion, pulmo-CT is a quick, simple method for quantitative confirmation of the presence of parenchymal abnormalities of lung as mosaic attenuation and should be used in combination with other radiological methods and PFT as it gives additional information to routine examinations in patients with emphysema.

Single-nucleotide polymorphisms in the genes that code for coagulation factors V (factor V Leiden) and II (prothrombin, G20210A), as well as the methylenetetrahydrofolate reductase (MTHFR, C677T) gene, have been implicated in the majority of cases of hereditary thrombophilia. We have developed a multiplex PCR-RFLP assay based on MnlI endonuclease digestion for the simultaneous detection of mutations in the FV, FII, and MTHFR genes. Digested amplification products were analyzed by gel electrophoresis in a single gel lane and visualized by ethidium bromide. This approach is a rapid and convenient method, hence economic, that alternate to others described for the detection of FVL, G20210A and C677T mutations.

Introduction: We evaluated chest X-ray and clinical findings of patients with lower respiratory tract infection due to influenza H5N1 and presented the radiological findings and clinical course of the infection., Materials and Methods: Between December 2005 and February 2006, eight hospitalized patients (median age 10, 5-15 years) with avian-flu were evaluated in this study. All patients were evaluated with chest X-ray and four of them with CT scan. Post mortem pathological characterization were also available for three of the patients., Results: A rapidly progressive pneumonia with high mortality rate was observed especially for cases with late admission. The major radiologic abnormalities were extensive pneumonic infiltration with segmental and multifocal distribution, mostly located in lower zones of the lung. No pleural effusion and hilar lymphadenopathy was noted., Conclusion: Avian flu may be presented as rapidly progressive pneumonia. The chest radiography has an important role in diagnosis and should be obtained daily because of rapid change of the findings that may necessitate prompt action.

Objectives: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through a sinus ostium, and extends into the choana. The common presentation of ACP is unilateral nasal obstruction. The radiographic findings and differential diagnosis of ACPs are discussed by comparing them with data in the literature., Method: This study included 19 (14 male, 5 female; median age 24.5 years, range 8-75 years) surgically treated patients with ACPs diagnosed by clinical examination, nasal endoscopy, and computed tomography., Results: Nasal obstruction was found in all cases. Endoscopic sinus surgery was preferred for removal of the nasal part of ACPs in 13 cases. Only in one case, polypectomy combined with Caldwell-Luc operation and septoplasty was performed. The observed complications were as follows: minor hemorrhage in three cases, mild cheek swelling with pain in two patients, and infraorbital hypoesthesia in one case. Histopathologic examination of ACPs revealed loose mucoid stroma and mucous glands, which were covered by respiratory epithelium., Conclusion: Endoscopic sinus surgery may be indicated in patients with ACPs because the function and capacity of the maxillary antrum are preserved. The greater portion of the antral part of polyp can be removed while leaving the healthy antral mucosa intact.

Symptomatic hypoglycemia is an unusual complication in children receiving oral purine analogues for treatment of childhood acute lymphoblastic leukemia (ALL). The exact mechanism of the hypoglycemic effect of the antimetabolic therapy remains unclear. Reduced hepatic glycogen stores or impaired hepatic glyconeogenesis may partly explain the hypoglycemia. To prevent hypoglycemia, food containing complex carbohydrates is recommended before sleep. In severe cases of hypoglycemia due to 6-mercaptopurine (6-MP), the dose can be given in the morning and if this fails 6-MP can be discontinued for a short period of time. We report a 3-year-old child who developed severe early morning hypoglycemia episodes that resolved after decreasing 6-MP while receiving non-high risk ALL therapy.

Introduction: Grafts and flaps have been widely used to reconstruct scrotal defects due to Fournier's gangrene. Controversy still exists concerning the use of grafts and flaps because of the low protection provided by the grafts and the high volume of the flaps. We describe the use of an expanded groin flap for scrotum reconstruction., Technical Considerations: Three patients were treated for total scrotal tissue loss using this method. An expander was installed through an incision from the inferolateral aspect of the groin, and superthin flaps obtained after 3 weeks were dissected starting from the medial side. Care was taken during dissection, because the skin was thin on the lateral side, and dissection was performed in a subfascial fashion. Finally, the defect was covered with the lateral part of the expanded flap and the donor site was primarily closed., Conclusions: To cover the testes, both the aesthetic and functional state should be taken into consideration. Therefore, a thin and durable cover is required for scrotal reconstruction. The expanded superthin groin flap possesses these features and is a good option.

A 26-year-old woman in the 28th week of pregnancy presented with a primary cerebral hydatid cyst manifesting as deteriorating consciousness and weakness in the left arm and leg. Cranial computed tomography revealed an intracranial hydatid cyst. The cyst was surgically removed and albendazole was administered. The patient had a spontaneous vaginal term delivery and no problem was observed in the mother or child. No primary focus was found in the lungs, liver, and other organs. Hydatid cyst is still an important disease. Intracranial hydatid cyst without primary foci in organs such as the liver and lungs is very rare. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention.

Objective: This study aimed to investigate the localization of the lipoma, as well as associated intracranial and extracranial lesions in 14 patients immediately following hospital admission. The pathological findings from the neurological examinations of these patients are also investigated., Methods: Fourteen patients who were admitted to our clinic with a variety of symptoms and diagnosed with intracranial lipoma were included in the study. Problems presented upon admission, neurological findings, and other existing system abnormalities were evaluated. Localization of the lipomas and accompanying pathologies were determined by using computerised tomography and magnetic resonance imaging., Results: The most frequent reasons for admission of patients with intracranial lipomas were: headache 7 (50%), trauma 3 (21.5%), epilepsy 3 (21.5%) and one with symptoms due to the local mass effect of tumor (7%). Although the pericallosal region is accepted as the region where lipomas commonly occur, this study found the most frequent occurrence in the quadrigeminal cistern. Intracranial lipoma calcification was only evident in 1 of the 14 patients. In addition, contrary to the expectations, intracranial and extracranial lesions accompanying lipomas were rare. All patients received systematic treatment., Conclusion: This study showed that intracranial lipomas are more frequent in the quadrigeminal region of the brain; most are asymptomatic, generally caught incidentally; and accompanying intracranial and extracranial pathologies are less common than expected.

We report a 52-year-old woman with a right renal pelvic stone, mimicking a left upper ureteral stone in a kidney-ureter-bladder film. Computed tomography detected the exact anatomical location of the stone, which was not possible by intravenous urography and ultrasonography. In this study, we discuss diagnostic modalities of the urinary calculi in the light of the literature.

Purpose: To assess the magnetic resonance imaging (MRI) signal and contrast-enhancement features of uterine fibroids before and after embolization, and to determine whether or not there are pre-embolization MRI characteristics that predict the volume reduction of fibroids., Material and Methods: Uterine fibroid embolization (UFE) was carried out in 28 fibroids of 20 patients, all of whom were symptomatic. The patients were prospectively evaluated with T1-weighted, T2-weighted, and gadolinium-enhanced T1 MRI sequences before and 6 months after embolization. The relationship between the characteristics of MRI signal and contrast-enhancement features of fibroids before the procedure and the change in size of the lesions after treatment was investigated., Results: Before embolization, the mean volume of fibroids was 123 cm3 (8-560 cm3). The decrease rate in fibroid volumes was 44.6% (range 7-70%) 6 months after embolization. Volume reduction was more prominent in fibroids that had a high signal intensity on T2-weighted images and a marked contrast enhancement on T1-weighted images (P < 0.001). However, the volume reduction was insufficient in fibroids with high signal characteristics on pre-contrast T1-weighted images (P < 0.001)., Conclusion: MRI is an effective method for revealing size and signal changes of fibroids after embolization. MRI signal characteristics and the contrast-enhancement pattern of fibroids before embolization can predict tumor volume reduction after embolization.

Objectives: Rhinolithiasis is the presence of mineralized and calcareous formations located in the nasal cavity. They have rare occurrence and can be easily confused with infection or obstruction of upper airways. If they are undetected for a long time, they may grow large enough to cause of nasal obstruction, mimicking sinusitis. Seven cases of rhinolithiasis were presented, and their diagnosis was made by rigid endoscopic nasal examination. Also computerized tomography scan was used to describe the size and site of the rhinoliths accurately. Our purpose was to determine the role of rigid nasal endoscopy in the diagnosis and the treatment of rhinolithiasis., Methods: In this study, seven cases of rhinolithiasis, who were diagnosed and treated by rigid nasal endoscopy were presented., Results: Between January 2000 and November 2004, seven cases (four males and three females; age ranged from 8 to 45 years) with rhinolithiasis were diagnosed. The most frequent symptoms were nasal obstruction with purulent rhinorhea, nasal and oral malodor. As complementary examinations, computerized tomography and simple X-ray of paranasal sinuses were used to locate and measure the dimension of calcareous mass, and to reveal possible invasion of the adjacent structures. The removal of rhinolithiasis was done with rigid nasal endoscopy under topical anesthesia in six cases and general anesthesia in one case., Conclusion: Rhinolithiasis is a rare condition but must always be suspected in patients with long standing nasal obstruction, nasal and oral malodor, purulent rhinorrhea and chronic headache.

We report a case of recurrent squamous cell carcinoma (SCC) of the scalp with deep cerebral invasion in a 15-year-old girl. Plain films and CT showed extensive, full thickness, and skull destruction at the vertex. Gadolinium-enhanced MRI revealed neoplastic invasion of the meninges and both cerebral hemispheres down to the lateral ventricle. This case represents an example of (SCC) imitating a primary brain tumor by exhibiting intracranial extension., (2005 Wiley-Liss, Inc.)

Objective: The objective of our study was to evaluate lactulose solution as a new oral contrast agent with the use of peroral CT enterography to determine the adequacy of luminal distention and conspicuity of the bowel wall., Conclusion: Peroral CT enterography performed with lactulose solution is a simple and noninvasive method of evaluating the small bowel by obtaining good distention. It can also be used at routine abdominal examinations as a negative contrast agent instead of iodinated oral contrast medium, especially for CT angiography.

The retro-aortic left renal vein (RLRV) is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Varicocele is defined as venous dilation of the pampiniform plexus, and the left side is the most commonly affected. Several theories concerning the possible aetiology of varicocele are reviewed in the literature, but RLRV was not mentioned as an aetiologic factor of varicocele. in this study we investigated the percentage of RLRVs and their relation with varicocele. A total of 1,125 contrast-enhanced abdominal CT scans was examined to identify RLRVs. RLRVs were found in nine women (1.6%) and ten men (1.7%). We performed scrotal Doppler ultrasonography (US) for all affected men except one. Varicocele of varying degrees was found in seven of the nine male patients with RLRV (77%). RLRV could be one of the aetiological factors in the development of varicocele, and the cases with RLRV should be examined by scrotal Doppler US for the presence of varicocele.

Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serological and radiological findings. In this report, we present a 15-year-old girl with atypical hepatic EA infestation showing central punctate calcifications and contrast enhancement on the portal and late phases of CT and MRI. CT showed a hypodense mass involving more than half of the liver with prominent central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. Contrast enhancement is a unique finding in hepatic EA infestation that may cause difficulties with diagnosis. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.

Intrathecal chemotherapy and systemic chemotherapy are used for both prophylaxis and treatment of central nervous system disease in hematologic malignancies. However, intrathecal treatment has some adverse effects, such as arachnoiditis, progressive myelopathy, and leukoencephalopathy. The authors describe six children in whom myelopathy and adhesive arachnoiditis developed after administration of intrathecal chemotherapy including methotrexate, cytosine arabinoside, and prednisolone. Urinary retention and incontinence, the main presenting complaints in all patients, developed within 12 hours after intrathecal therapy and spontaneously resolved within 7 days. Two patients were unable to walk. In these two, weakness in the lower extremities gradually recovered by 1 month but urinary incontinence did not improve. None of the children had sensory loss. On follow-up periodic recurrent urinary tract infection was noted in four patients. MRI findings corresponded to arachnoiditis. No response was recorded on tibial nerve somatosensory evoked potentials in all patients. Intrathecal chemotherapy, especially methotrexate, can cause spinal cord dysfunction in children with acute lymphoblastic leukemia and non-Hodgkin's lymphoma. Arachnoiditis should be kept in mind as a causative factor in recurrent urinary tract infection in patients receiving intrathecal chemotherapy.

We describe herein the use of MR fluoroscopic guidance in the drainage of abscess cavities. We percutaneously drained 12 brain abscesses in 11 patients. A 0.3T open MR imaging system was used. Sixteen drainages were performed in 12 abscesses. Repeat drainage was needed in three recurrences and one residual lesion. No serious complications were seen. MR fluoroscopy-guided percutaneous brain abscess drainage in an open MR imaging system is feasible.

Infantile hemangioendothelioma is a rare benign hepatic tumor arising from mesenchymal tissue. Most of the cases present with congestive heart failure and asymptomatic abdominal mass were before 6 months of age. We described a patient with projectile vomiting, which is quite an unusual presentation. Following surgical resection, neither recurrence nor symptoms were seen in 2 years of follow-up., ((c) 2004 Wiley-Liss, Inc.)

A Thornwaldt's cyst is an uncommon nasopharyngeal lesion that develops from the remnant of the primitive notochord. A 65-year-old man with a Thornwaldt's cyst is presented in this case report. The patient was diagnosed by rigid nasal endoscopy and magnetic resonance imaging (MRI). These cases are infrequently presented in the English journals. Our study suggested that endoscopic and MRI examinations of the nasopharynx were a simple, rapid, and useful procedure for the diagnosis of the Thornwaldt's cysts.

Reperfusion injury, caused by free oxygen radicals, is a chain of events that occurs in tissues exposed to a constant period of ischemia. The antioxidant vitamins E and C (VEC) and hyperbaric oxygenation (HBO) have beneficial effects in treating ischemic tissues following skin flap operations. In our study, we aimed to compare the effects of VEC and/or HBO in ischemia-reperfusion injury induced by free oxygen radicals in an experimental rat epigastric island skin-flap model. Eight hours of ischemia was provided by clamping the inferior epigastric pedicle following the flap elevation. The flap survey was determined to be 28.6% in controls, 59.2% in HBO group, 66.3% in VEC + HBO group, and 82% in VEC group (p < 0.05). We conclude that although HBO and/or VEC increased the flap viability significantly by reducing ischemia-reperfusion injury, the most promising results were obtained in the antioxidant vitamins group.

Introduction: The aim of the study is to investigate the efficacy of the magnetic resonance fluoroscopy in the diagnosis and staging of the pelvic prolapse., Materials and Methods: The study consisted of 46 patients who were known to have pelvic prolapses from their vaginal examination. Thirty women who underwent vaginal exam and shown not have pelvic prolapse were selected as a control group. Firstly, pelvic sagittal FSE T2 weighted images of all the women were acquired in 0.3 T open MR equipment than sagittal MR-fluoroscopic images using spoiled gradient echo sequences were obtained during pelvic strain. Physical examination and MR-fluoroscopic findings were compared. The relationship between the stages of prolapse established by both of the methods was evaluated statistically with Pearson's correlation analysis., Results: Physical examination and MR findings were very concordant in the diagnosis of pelvic prolapse and statistical correlations in the stages of prolapse were established between both of the methods (P<0.01 for anterior and middle comportment, P<0.05 for posterior comportment)., Conclusion: We conclude that MR-fluoroscopy is a non-invasive, easily applied, dynamic useful method without contrast agent in the diagnosis and staging of pelvic organ prolapse.

A previously healthy 30-day-old girl presented with seizures, irritability and inability to sleep for three days. Vitamin K was not given just after birth. She was lethargic. A multifocal clonic seizure was evident during examination. Anisocoria was diagnosed on eye examination. Brain magnetic resonance imaging showed intracerebral hemorrhage, ventricular dilatation, and hematoma in the left temporofrontal region extending to the hypothalamus. Central diabetes insipidus was diagnosed by water deprivation due to dehydration and hypernatremia, and then desmopressin was added to phenobarbital. The possible mechanism of central diabetes insipidus in our patient is damage of vasopressin pathway resulting from compression of hemorrhage. An operation of ventriculoperitoneal shunt was also performed due to hydrocephalus. While she was symptom-free except for neurological sequel during routine control examinations after discharging from hospital, the parents said that she died, most probably from bronchopneumonia, at the age of 7.5 months. In conclusion, we emphasize that prophylactic vitamin K should be administrated to all babies just after birth, and infants with intracranial hemorrhage should carefully be monitored for central diabetes insipidus.