MR-guided endovascular interventions: a comprehensive review on techniques and applications

The magnetic resonance (MR) guidance of endovascular interventions is probably one of the greatest challenges of clinical MR research. MR angiography is not only an imaging tool for the vasculature but can also simultaneously depict high tissue contrast, including the differentiation of the vascular wall and perivascular tissues, as well as vascular function. Several hurdles had to be overcome to allow MR guidance for endovascular interventions. MR hardware and sequence design had to be developed to achieve acceptable patient access and to allow real-time or near real-time imaging. The development of interventional devices, both applicable and safe for MR imaging (MRI), was also mandatory. The subject of this review is to summarize the latest developments in real-time MRI hardware, MRI, visualization tools, interventional devices, endovascular tracking techniques, actual applications and safety issues.     

Incidence of auditory neuropathy among the deaf school students

OBJECTIVE: We aimed to determine the incidence of auditory neuropathy (AN) among the deaf school students that have severe hearing loss. METHOD: All students having severe hearing loss constituting a total of 75 at Deafness school in Afyon Province of Turkey were enrolled in the study. The etiological factors about the hearing loss were determined by performing an individual file survey and by interviewing the teachers and parents. First, all the children were subjected to an otolaryngologic examination. Then, auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests were done to all students enrolled in the study. RESULTS: The ages of the children were between 6 and 17 (mean age 11.9) and 32 (42.9%) of them were girls and 43 (57.1%) were boys. Three cases (4%) were diagnosed as AN in our study, however, no risk factors were determined in two of them. A history of hearing loss following a vaccination was found in only one patient. CONCLUSION: Our data show that the incidence of AN in the children with severe hearing loss is not negligible. Therefore, our results suggest that automatic ABR should be also used with OAE as a routine application in the neonatal screening programmes, since the solely use of OAE in the neonatal screening programmes may result in the delay of the diagnosis of the children with AN.     

Visualization of the biliary tract using gadobenate dimeglumine: preliminary findings

OBJECTIVE: To compare contrast-enhanced magnetic resonance (MR) cholangiography (CE-MRC) performed with gadobenate dimeglumine with T2-weighted MRC (T2-MRC) for visualization of the bile ducts in nondilated biliary systems. MATERIALS AND METHODS: Twenty consecutive patients who underwent MR imaging (MRI) of the liver and pancreas with nondilated intrahepatic ducts were included in this retrospective study. T2-weighted MRC was performed using a multislice, high-resolution fat-suppressed half-Fourier acquisition turbo spin-echo sequence. Contrast-enhanced MR cholangiography was performed using a fat-suppressed 3-dimensional fast low-angle shot sequence acquired 1 to 1.5 hour after intravenous administration of gadobenate dimeglumine. For image interpretation, the biliary system was divided into 8 segments. Two readers graded visualization of each segment on T2-MRC and CE-MRC using a 5-point scale (0, nonvisualization; 4, excellent visualization). Final opinion for each sequence was rendered by consensus. Superiority of visualization was assessed using the McNemar test and comparing adequately (visualization scores 3 and 4) and inadequately (visualization scores 0, 1, and 2) visualized segments of the ducts on both sequences. Interobserver variability was assessed with kappa statistics. RESULTS: Overall and segment-based evaluation revealed superior visualization of biliary segments with CE-MRC compared with T2-MRC. We also found a statistically significant difference between the 2 sequences for overall and for right hepatic duct and cystic channel visualization (P < 0.05). A high concordance between readers 1 and 2 both for T2-MRC and CE-MRC was achieved (85.8% and 89.4%, respectively). CONCLUSIONS: Gadobenate dimeglumine can be used as an alternative intrabiliary contrast agent for contrast-enhanced MR cholangiography in nondilated biliary systems in patients with normal excretory liver function tests.     

Can mucosal sealing reduce tonsillectomy pain?

OBJECTIVE/HYPOTHESIS: The hypothesis tests whether sealing the tonsillectomy field with posterior pillar mucosa can prevent unwanted outcomes in pediatric tonsillectomy. STUDY DESIGN: A prospective, randomized, single blinded study was conducted on a sample of 39 children between 3 and 15 years of age. After dissection and snare tonsillectomy, the tonsillar fossa was covered on one side using the palatopharyngus mucosa and the other side is used as control. Pain scores, healing, edema and infection at the operation site were investigated. METHODS: The tonsillectomy sites were randomly assigned into one of two groups. First group contained the ones with mucosal flap sealed over the operation site and the second group was kept as control with the operation site left uncovered. All of the patients received mild analgesics. The pain assessment is done on Days 1, 3, 5, 7 and 10 postoperatively, by using Wong-Baker faces visual analog scale. On the 10th postoperative day, the operation field of each side is scored separately for edema, healing and infection. Statistical investigation was performed through a software program. RESULTS: On first postoperative day, pain level difference was not statistically significant between the two groups (p>0.01). But from 3rd to 10th postoperative day, the pain level was found out to be lower in the mucosa sealed site (p<0.01). On the 10th postoperative day, while the edema was significantly more (p<0.01), healing was better (p<0.01) at the sutured site. Postoperative infection at operation site was not different between the groups (p>0.01). CONCLUSION: Covering tonsillectomy field with mucosal palatopharyngeal arch flap significantly reduces pain after third postoperative day. The flap side had better healing when compared to denuded site. But the sutures in the mucosal flap may cause more tissue edema. Sutures have no significant effect on postoperative infection. Thus, mucosal flap may be used as an adjuvant surgical technique to decrease tonsillectomy pain of children in addition to the analgesic medication.     

Fatty liver due to high levels of serum tacrolimus after liver transplantation

Tacrolimus has been used extensively for immunosuppressive therapy in pediatric liver transplant recipients. However, patients who are exposed to high levels of serum tacrolimus tend to be associated with a higher incidence of significant nephrotoxicity, neurotoxicity, pruritus, alopecia, diabetes and infection. We herein report a child who developed increased serum transaminase levels and liver steatosis as a result of raised trough blood level of tacrolimus (30 ng/ml for 3 days) in association with rotavirus gastroenteritis.     

Bullying behaviours and psychosocial health: results from a cross-sectional survey among high school students in Istanbul, Turkey

The aim of this study was to investigate bullying behaviours and their associations with health and health risk behaviours. This study involved completion of the Health Behaviour in School-Aged Children (HBSC) and Youth Self Report (YSR) questionnaires by 3,519 students. Of the students, 59.4% (n=2,091) were neither bullies/nor victims, 22% (n=774) victims, 9.4% (n=331) bully/victims and 9.2% (n=323) bullies. Generally, students involved in bullying behaviours were more likely to have higher YSR scale scores than students who were not involved in bullying behaviours. Bully/victims had higher scores on the YSR subscales than others. Students involved in bullying behaviours were more likely not to use seat belts, to watch TV >or= 4 h/day, to be involved in a physical fight, to skip class and to spend time with friends than students who were not involved in bullying behaviours. Bully/victims and bullies were more likely to smoke cigarettes, to drink alcohol, to be drunk, to play computer games and to be sexually active than others. Bully/victims were more likely to have less educated mothers and to have difficulty in talking to both parents than others. Victims were more likely to have a lower socioeconomic status, to have difficulty in talking to opposite gender friends and to have difficulty in making new friends than others. Bullying behaviour is common and associated with other risk behaviours and psychological health problems in Istanbul high school students. Health professionals should be aware of the influence of bullying on health and particularly on bully/victims' health. There is a strong need for bullying prevention programmes in schools in Turkey.     

Pathergy reaction in different body areas in Behçet's disease

Behçet's disease (BD) is a chronic inflammatory multisystemic disorder characterized mainly by vasculitis. Although the pathergy reaction (PR) has been accepted as one of the major criteria in this disease, there is a lack of a standardized method to measure PR. The aim of this study was to evaluate results of PR in different body areas and the effect on the positive rate of PR of application of numerous needle pricks. The pathergy test was performed using simultaneous 16 needle pricks with 20G disposable needles on different body areas of 56 patients with BD, 49 patients with recurrent aphthous stomatitis (RAS) and 17 healthy subjects. No positive PR was found in healthy controls, but was observed in nine patients with RAS (18.3%). It was detected in 48 of 56 patients with BD, a positive rate of 85.7%. The site most frequently positive for PR was the forearm, while the least frequent was the abdomen. Multiple needle pricks could play an important role in increasing the positive rate of PR in BD, and it may be important in the investigation of aetiological factors in RAS.