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Feb 2016 DOI 10.14302/issn.2379-8572.joa-15-906
Objective: We compared preoperative data of physical examination, CT and diffusion MRI findings of temporal bone with our intraoperative observations. We investigated the diagnostic efficiency of single-shot spin echo echoplanar diffusion MRI (SS SE EPI) on primary cholesteatoma. Methods: 33 patients with chronic otitis media who had been admitted to Otolaryngology Department of Haydarpasa Numune Training and Research Hospital between June 2010 and September 2011 were involved in this study. All patients did undergo otoscopic and audiometric examination. After imaging of temporal bone by CT and diffusion MRI, patients were operated and intraoperative observations were recorded. Patients with intraoperatively approved cholesteatoma were defined as group 1 and those without cholesteatoma were defined as group 2. Perioperative and preoperative findings of physical examination, CT and MRI of all patients were compared one by one. Results: Positive physical examination findings have been superior to MRI and CT, having a sensitivity of 96%, specifity of 87.5%, positive predictive value of 96% and negative predictive value of 87.5%. In terms of effectiveness of MRI in diagnosing intraoperative cholesteatoma, we had a sensitivity of 80%, specifity of 50%, positive predictive value of 83.3% and negative predictive value of 44.4%. These values are also lower than previously reported results. Conclusion: When we had preoperative suspection of cholesteatoma on physical examination and diffusion MRI, in addition with bone tissue erosion on CT, we found that physical examination is superior to MRI and CT in terms of capability of diagnosing the disease.
Oct 2015 DOI 10.14302/issn.2470-0436.jos-14-571
Purpose: To describe a new functional magnetic resonance imaging (fMRI) method for measuring the influence of regular astigmatism, both against-the-rule (ATR) and with-the-rule (WTR), on the human visual cortex. Setting: Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan. Design: Experimental study. Methods: Images were acquired in two healthy volunteers using a 1.5 T scanner equipped for echo planar imaging. Horizontal and vertical sine wave grating flickering at a frequency of 8 Hz were simultaneously presented during the 20-second stimulation period. During the control period , subjects fixated on a control target. Stimulations were performed under three different conditions that included with hard contact lenses that were equal to emmetropia without astigmatism (condition 1); with hard contact lenses and cylindrical glasses of +6.00D at 0°, imitating WTR (condition 2); and with hard contact lenses and cylindrical glasses of +6. 00 D at 90°, imitating ATR (condition 3). Raw data were processed using in-house software with the significance of activation determined by Statistical Parametric Mapping (SPM 99). Results: Although higher activation was found in the primary visual cortex for condition 1 versus conditions 2 and 3, activation in the dorsal pathway was higher in conditions 2 and 3 compared to condition 1. Dorsal pathway activation was also higher in condition 3 versus condition 2. Conclusions: Study findings showed the potential influence of ATR and WTR on the human visual cortex , with fMRI able to detect the influence of regular astigmatism on the visual cortex. Our current results suggest that fMRI may be useful in exploring the influence of astigmatism on vision.
Dec 2022 DOI 10.14302/issn.2574-4526.jddd-22-4151
Steroid cell tumors of the ovary are particularly rare, secreting sex hormones, characterized by steroid cell proliferation and represent only 0.1% of all ovarian tumors. They are classified into three subtypes according to their cell of origin: stromal luteoma, Leydig cell tumors and a third subtype of unknown lineage corresponds to a not specified steroid cell tumor (SCT-NOS). This third subtype accounts for 60% of steroid cell tumors. The clinical manifestations of SCT-NOS can take many forms, including pain, abdominal distension, but perhaps the most visible presentations are those related to hormonal activity and virilization of the tumor. We present a rare case of a 48-year-old woman with vaginal bleeding and a history of trunk obesity, hirsutism for 2 years and hypothyroidism with hormone replacement therapy. Clinical examination revealed a characteristic of obesity, virilization. Serum testosterone was 3.62 µg / L and CA-125 was 40.67. Magnetic resonance imaging identified a left ovarian solid mass and histopathology confirmed a steroid cell tumor not specific. The patient underwent exploratory laparotomy and left salpingoophorectomy. Macroscopically, the mass is well circumscribed, solid, homogeneous and yellowish. Microscopically, the tumor is mainly composed of eosinophilic or vacuolar granular cytoplasm. Immunohistochemistry showed that the tumor cells were strongly positive for inhibin. The postoperative period was uneventful. Through this rare observation, we will discuss the aspects that characterize this type of tumor and present some guidelines to be used in the differential diagnosis, as well as the difficulties encountered in the clinical, radiological and therapeutic fields.
Nov 2021 DOI 10.14302/issn.2470-0436.jos-21-4003
This is a case of a pediatric patient who presented with a sudden onset of right abducens nerve palsy with contralateral hemiplegia with no facial paralysis. With the constellation of symptoms aided by the presence of enhancing pontine mass on magnetic resonance imaging, the presence of diffuse intrinsic pontine glioma (DIPG) was presumed to have caused the findings consistent with the common type of Raymond syndrome.
May 2021 DOI 10.14302/issn.2766-8681.jcsr-21-3783
Background Klippel-Feil Syndrome (KFS) is described as the clinical triad of short neck, low posterior hairline, and limitation of neck mobility. Objective Topresent our clinical experience with KFS patients who also had adjacent segment disease (ASD) and to propose a novel classification system for these patients. Methods This retrospective study was performed in the neurosurgery department of our tertiary care center. Data were gathered using the medical records of 22 KFS patients (10 males, 12 females) with ASD. Diagnosis was confirmed with imaging modalities including X-ray, computerized tomography, and magnetic resonance imaging. Clinical and radiological findings as well as therapeutic outcomes were noted. Results The average age of our series was 56.09 (range: 41 to 67) years. The operative technique was selected as for our novel “Yilmaz-Yucesoy Classification System”. Accordingly, one patient (4.54 %) received non-surgical treatment (Yilmaz-Yucesoy Grade 1), six cases (27.27 %) underwent anterior cervical arthroplasty, seven patients (31.81 %) underwent anterior cervical discectomy or corpectomy and fusion with cervical cage and plate (Yilmaz-Yucesoy Grade 3). Eight patients (36.36 %) with cervical spinal instability had anterior cervical discectomy or corpectomy and fusion with cervical cage and plate (Yilmaz-Yucesoy Grade 4). No mortality or remarkable complications were detected. Conclusion Appropriate and timely recognition and classification of patients with KFS and ASD based on our newly proposed “Yilmaz-Yucesoy Classification System” yielded promising treatment outcomes. However, further prospective, randomized, controlled trials are warranted on larger series to validate our preliminary results.
Apr 2020 DOI 10.14302/issn.2372-6601.jhor-20-3293
Objective Meningiomas are most common intracranial benign tumors comprising around one third of all intracranial neoplasms, and typically have benign and indolent nature with slow-growing behaviour. Benign meningiomas are slow growing tumors typically following an indolent disease course. Nevertheless, atypical or anaplastic meningiomas may follow a more aggressive disease course with invasion of critical structures and recurrences. In the current study, we evaluate the incorporation of magnetic resonance imaging (MRI) for radiosurgery treatment planning of atypical meningiomas. Materials and Methods Atypical meningioma radiosurgery target volume determination with and without incorporation of MRI has been evaluated. Ground truth target volume used as the reference has been outlined by the board-certified group of radiation oncologists after comprehensive assessment, thorough collaboration and consensus. Results Target volume definition by use of Computed Tomography (CT)-only imaging and by CT-MR fusion based imaging has been comparatively evaluated in this study for linear accelerator (LINAC)-based radiosurgical management of atypical meningioma. Ground truth target volume defined by the board-certified radiation oncologists after detailed evaluation, collaboration, colleague peer review and consensus has been found to be identical to target determination by use of CT-MR fusion based imaging. Conclusion Despite significant progress in neurosurgical techniques over the years, complete surgical resection may not be feasible in the presence of meningiomas located at eloquent brain areas in close association with important neurovascular structures. RT may have a role in multidisciplinary management of meningiomas. Incorporation of MRI into treatment planning for radiosurgery of atypical meningiomas may improve target definition despite the need for further supporting evidence.
Nov 2019 DOI 10.14302/issn.2641-5518.jcci-19-3098
Idiopathic retroperitoneal fibrosis also known as Ormonds disease is a rare disorder characterized by the development of fibrotic tissue in the retroperitoneum. The fibrotic tissue may compress ureters, leading to obstructive nephrouropathy and renal failure. A 58-year-old man with fatigue, loss of appetite and unable to urinate was admitted to our clinic. Because of the serum creatinine value of 5.3 mg/dl, urinary ultrasonography was performed and bilateral grade 3 hydronephrosis with moderate level urine in bladder was detected. Hydronephrosis did not regress by transurethral foley catheter and suspicious appearance in the retroperitoneal area was found in abdominal magnetic resonance imaging. Tru-cut biopsy result of the current lesion was finally reported as a connective tissue. Bilateral double j catheter insertion was performed and started to immunosuppression therapy with corticosteroid. Two months later, double j catheters were removed and hydronephrosis was not detected in follow-up. In this case report, we tried to explain that, retroperitoneal fibrosis should be considered in the differential diagnosis of postrenal acute renal failure, even in patients without a classic symptom such as pain. In addition, early surgical intervention should be avoided in such patients.
Aug 2019
Objective Antisocial behavior (ASB) in children and youth is public health problem in Georgia. Nevertheless, there has been no systematic study the risk factors for ASB that could counteract on ASB development. To prevent ASB development and acceleration the understanding of biological (assessment of Brain morphology using MRI) and psychological (assessment using Freiburg Personality Inventory) risk factors is critical. This was the aim of this study. Method The children/youth with ASB tendency (AST) were identified by the Freiburg Personality Inventory (FBI). The biological and psychosocial factors contributing to AST were evaluated using a semi-structured clinical interview. Brain anatomy and morphology was studied using magnetic resonance imaging (MRI). Results Children/youth with AST had significant abnormalities in most axial elements of the DSM multi-axial system but not in brain anatomy measured by MRI. Conclusion Early identification of ASB tendencies and a provide correlationship between specific psychiatric, medical and family stress factors will likely reduce the number of children/youth with ASB and will promote their integration into society.
Apr 2019 DOI 10.14302/issn.2998-4211.jalr-19-2658
Alzheimer’s Disease (AD) is one amongst the overwhelming types of dementia that distresses the brain nerve cells leading to a perpetual loss in memory and creating a lot of difficulties for the family members in caretaking. The prediction of the disease at an earlier stage is a common problem. The most prevalent imaging modalities used for diagnosing AD are Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT). They can provide valuable information regarding the changes in internal and external brain regions and activities for diagnosing AD. But the relevant studies made on retina reveals that in addition to brain changes there are some variations on the retina layers of the AD patients. Therefore, the retina can be used as a biomarker for diagnosing AD. There are different techniques available for an eye examination. Most noticeable of them are Fundus Imaging and Optical Coherence Tomography (OCT). In this paper, we have focused on OCT retinal images of AD patients for the early diagnosis of AD.
Mar 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2655
Reverse Shapiro’s syndrome is described as unexplained hyperthermia coexisting with agenesis of the corpus callosum. Its pathophysiology dwells on the role of dopaminergic hypersensitivity caused by hypothalamic dysfunction. Until now, only 5 cases have been described in the literature as reverse Shapiro’s syndrome. We present a case of a 6-month-old girl who is now the sixth patient described in the literature. A 6-month-old female patient was admitted to the pediatrics unit for fever of unknown origin. Her fever occurred 2-3 times a day on average between 38°C and 39.5°C, and lasted for 1-2 hours. The fever was not diurnal, and antipyretics or staying in an air-conditioned room had no effect. She also had 2 convulsions during her hospital stay. Cranial magnetic resonance imaging (MRI) was requested owing to the patient’s convulsion history and retarded development. The cranial MRI showed diffuse hypoplasia of the corpus callosum in the midline sagittal T2-weighted image. T1-weighted imaging showed hypointensity due to delayed myelination of the genu of the corpus callosum (Figure 2, white arrow), which should normally appear hyperintense like the posterior limb of the internal capsule. Although dopamine agonists and serotonin agonists are recommended for the treatment, the rate of response to medical treatment is very low. Our patient did not benefit from cyproheptadine and methyl prednisolone.
Dec 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1803
Introduction: Non epileptic seizures (NES) are little reported in our country. Case report: We report 2 observations of 4 years old girls, with normal psychomotor development, and frequent paroxystic seizures, characterized by stereotyped movements of the members, occurring during sleep onset or deep sleep. Electroencephalogram Sleep records showed brief discharges of spikes and spikes-waves. Magnetic Resonance Imaging was normal. Suspicion of NES associated with epilepsy was based on the following arguments: mild regression of the seizures frequency after using antiepileptic drug video records of the seizures strongly suggestive of masturbation seizures, masturbation seizures are triggered by the girls and stopped on order, best regression of the seizures frequency after adjunction of trihexiphenidyl. Moreover, the authors make a review of literature on the NES. Conclusion: The early diagnosis of the NES allows to avoid the inadequate treatments and an improvement of the prognosis.
Dec 2017 DOI 10.14302/issn.2997-2086.jfs-17-1846
Introduction: Data support the use of both ultrasound (US) and magnetic resonance imaging (MRI) in the prenatal prognostication of congenital diaphragmatic hernia (CDH). The aim of this study was to examine our experience and learning curve with both of these diagnostic tools in the setting of a new fetal program. Materials and Methods: This is a case series performed as a quality improvement measure. Fetuses were identified at a single tertiary institution with both ultrasound lung-to-head ratio (LHR) and MRI fetal lung volume from December 2012 until July 2016. Prenatal and postnatal data were collected. Statistical analysis was performed and a p-value of <0.05 was considered significant. Results: Twenty-one patients met inclusion criteria. Inaccurate LHRs were found in 26.9% (7/26) of patients, with the lack of a four-chamber heart view as the most common inaccuracy (5/26, 19.2%). Patients with only some or no stomach in the thoracic cavity on fetal MRI had 100% survival to discharge. Discussion: Accurate prenatal prognostication of CDH is challenging. We identified a pitfall in attaining LHR that can be easily identified, and that may influence the accuracy of the measurement. Furthermore, stomach position on MRI is a relatively newly described quick, easy, and reproducible metric for predicting prognosis.
Sep 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1733
Spontaneous dissection of the cervical segment of the internal carotid artery (CS-ICA) is uncommon but not rare. A 43-year-old man suddenly developed complete right hemiparesis with motor aphasia. 3 weeks after the initial symptom onset. Magnetic resonance imaging showed enlargement of an intramural hematoma at the cervical carotid artery; it severely compressed and completely occluded the arterial lumen. Diffuse ischemia was observed in the area of the left middle cerebral artery (MCA) immediately after onset and he underwent emergency left superficial temporal artery-MCA double bypass within 6 hours. There was no fatal deterioration and his neurological deficit was resolved. We discuss our treatment of spontaneous dissection of the CS-ICA to prevent ischemic damage.
Sep 2017 DOI 10.14302/issn.2576-9359.jot-17-1594
Constrictive pericarditis (CP) represents a rare complication after heart transplantation (HTx), resulting from various postoperative events such as mediastinitis, pericardial effusion, or allograft rejection. We describe our recent experience with managing an HTx recipient who developed atypical patterns of CP predominantly involving the right ventricle. A 52-year-old male who had received heart transplantation 2.5 years before was admitted to our institution because of progressive symptoms of heart failure. The patient had experienced acute rejection twice post-HTx, both with International Society for Heart and Lung Transplantation grade 1R, undergoing an additional endomyocardial biopsy other than those performed during regular check-ups. On admission, echocardiography revealed paradoxical septal motion and a large cystic-like mass with a thick capsule in front of the right ventricle. Right heart catheterization revealed elevation of right atrial pressure, with severely reduced cardiac index. Magnetic resonance imaging revealed both seroma and a thick cystic-like capsule tightly adhered to the right ventricle. CP was suspected despite the atypical patterns of presentation. Seroma was removed through exploratory lateral thoracotomy, without improvement in symptoms, which was only achieved via subsequent pericardiectomy involving resection of the thickened parietal pericardium, removal of effusion fluid, and further excision of diffusely thickened visceral pericardium and epicardium. The patient is currently recovering uneventfully. The possibility of CP after HTx should be considered despite the rarity of this condition and HTx recipients should be closely monitored using various imaging modalities because CP typically demonstrates non-specific symptoms and physical findings of heart failure, with high mortality.
Oct 2015 DOI 10.14302/issn.2470-5020.jnrt-15-726
Background: A higher incidence of symptomatic lacunar infarction (LI) was confirmed in metropolitan areas. The aim of this study was to determinethe prevalence characteristics and early predictors of LI in a population of elderly outpatients in northern China. Methods: From February 2011 to March 2012, a retrospective cohort of new patients was selected for study, all registered neurologic outpatients of the tertiary teaching hospital in northern China. A total of 453 outpatients, clinically only having had an initial visit and a magnetic resonance imaging study of the brain, were enrolled. The prevalence characteristics and vascular risk factors of LI were assessed. Results: Of 453 symptomatic outpatients, 258(57.0%) patients had symptomatic LI. We found that the main types of symptomatic LI were nonfocal symptoms, such as dizziness and headache, dizziness/vertigo, and migraine/headache. Age, BMI, smoking, history of hypertension, duration of hypertension, existing hypertension, headache and dizziness, pure motor hemiparesis, blood glucose, hypercholesterolemia, systolic blood pressure, and ABCD2 score, were significantly higher in patients with LI than in those without LI (P<0.05). Multivariate logistic regression confirmed that hypertension ≥3years in duration (odds ratio=1.092; 95% CI, 1.019 -1.170) and a median mABCD2 score ≥4 (odds ratio=3.912; 95% CI, 2.955- 5.180) were independent, early predictors of symptomatic LI. Conclusions: The incidence of LI in Northern China was located at the higher end of range in northern China, and common type of symptomatic LI was nonfocal symptoms. Hypertension of long duration and high-risk ABCD2 scores are early predictors of symptomatic LI.