Comparison of vertebral artery velocity and flow volume measurements for diagnosis of vertebrobasilar insufficiency using color duplex sonography

INTRODUCTION: The aim of this study was to compare the measurements of vertebral artery (VA) systolic flow velocity and flow volume for diagnosis of vertebrobasilar insufficiency (VBI). MATERIAL AND METHODS: We examined 96 patients who were referred for evaluation of VBI. Net vertebral artery flow volume and mean systolic flow velocity were determined by using color duplex sonography. We had grouped the patients into three according to VA flow volume: group 1 was consisted of patients with severely damped VA flow volume (lower than 120 mL/min), group 2 was consisted of patients with moderately damped VA flow volume (120-200 mL/min), group 3 was consisted of patients with normal VA flow volume (>200 mL/min). The mean systolic flow velocities in each group were compared by one-way ANOVA. RESULTS: Mean VA systolic flow velocities of groups 1, 2 and 3 were 32 +/- 12, 42 +/- 10 and 46 +/- 8 cm/s, respectively. Mean VA systolic flow velocity in group 1 was significantly lower than that of group 2 (P = 0.001). However, there were no significant differences between VA systolic flow velocities in groups 2 and 3 (P = 0.2). CONCLUSIONS: According to our findings, measurement of volume in addition to velocity is more valuable in detection of moderately damped VA flow volumes in diagnosis of VBI.     

Circulating levels of ghrelin,galanin, and orexin-A orexigenic neuropeptides in obstructive sleep apnea syndrome

Sleep and Breathing - The orexigenic peptides, ghrelin, galanin, and orexin-A, have an important role in food intake and energy homeostasis and regulate the higher brain functions including the...     

Features of patients with vulvar dermatoses in dermatologic and gynecologic practice in Turkey: is there a need for an interdisciplinary approach?

AIM: Vulvar dermatoses are very common problems in women and they are associated with significant morbidity. The aims of the present study were to evaluate the features of patients with vulvar diseases in gynecology and dermatology out-patient clinics in Turkey, and to determine the need for a multidisciplinary vulvar clinic in this country. METHODS: A total of 310 patients with vulvar problems as their primary complaints were included in the study. There were 144 women from a dermatology clinic and 166 women from a gynecology clinic. The following factors were recorded for all patients: physical examination findings, menarche age, age at first intercourse, education level, marital status, clinical diagnoses and associated gynecologic problems. RESULTS: There were no significant differences between the two groups when the mean age, menarche age and age at first intercourse were compared (P > 0.05). The number of unmarried women was statistically significantly higher in the dermatology group than in the gynecology group (P < 0.0001). The number of women who graduated from high school and university was also statistically significantly higher in the dermatology group than in the gynecology group (P < 0.01). The frequency of gynecologic problems was statistically significantly higher in the gynecology group than in the dermatology group (P < 0.001); however, dermatologic conditions were the most frequent diagnosis overall (33.54%). Forty patients in the gynecology group were referred to the dermatology clinic. CONCLUSIONS: The approach to patients with vulvar disorders varies from country to country. However, multidisciplinary clinics seem to improve the understanding of vulvar diseases, to make correct diagnoses and to raise patients' quality of life. The need for a multidisciplinary vulvar clinic should not be ignored by the physicians in Turkey.     

Unmet need in Behcet’s disease: most patients in routine follow-up continue to have oral ulcers

The clinical course of Behcet’s disease (BD) as a multisystemic disorder with a remitting-relapsing nature is insufficiently explored. As complete remission should be aimed in all inflammatory diseases, we investigated the frequency of complete remission in patients with BD followed in long-term, routine practice. In this retrospective study, 258 patients with BD who were regularly followed in outpatient clinics were assessed. The demographic and clinical data for active organ manifestations and treatment protocols were evaluated, and “complete remission” for this study was defined as no sign of any disease manifestation in the current visit and the preceding month. Two hundred fifty-eight patients with BD (F/M 130/128, mean age 41.1?±?11.5 years) were included to the study. Mucocutaneous disease was present in 48.4 % (n?=?125). Mean visit number was 6.8?±?2.7, and mean follow-up duration was 45.8?±?36.5 months. Patients were clinically active in 67.2 % (n?=?1,182) of the total visits (n?=?1,757), which increased to 75.6 % (68.1–90.3) when the month preceding the visit was also included. The most common active manifestation was oral ulcers (39.4–63.2 %) followed by other mucocutaneous manifestations and musculoskeletal involvement. When multivariate analysis was performed, oral ulcers, which are the main cause of the clinical activity, negatively correlated with immunosuppressive treatments (β?=??0.356, p?β?=??0.183, p?=?0.04). It is fairly difficult to achieve complete remission in BD with current therapeutic regimens. The reluctance of the clinician to be aggressive for some BD manifestations with low morbidity, such as mucocutaneous lesions and arthritis, might be influencing the continuous, low-disease activity state, especially due to oral ulcers, in BD patients.     

The Effects of Six-Month L-Thyroxine Treatment on Cognitive Functions and Event-Related Brain Potentials in Children with Subclinical Hypothyroidism

Objective:

The aim of this study was to investigate the cognitive status of children with subclinical hypothyroidism (SH) before and after L-thyroxine (L-T4) treatment using event-related potentials (ERPs) and neuropsychological tests.

Methods:

This prospective study was conducted on a series of 20 children with mild SH (free T4 normal and thyroid-stimulating hormone level within 5-10 µIU/L) who underwent clinical and cognitive assessment before L-T4 treatment and 6 months afterwards. The recordings of ERPs were done at the time of diagnosis and after 6 months of euthyroid state. Neuropsychiatric tests for attention, perception, close and remote memory were performed on all patients and on the control group which consisted of 20 healthy children of normal intelligence.

Results:

While pretreatment verbal memory (VM) and verbal recall (VR) scores of the SH group were significantly lower than those of the control group (p=0.004 and 0.012, respectively), no significant differences between the post-treatment and control groups were found in these scores after 6 months of L-T4 treatment. Post-treatment VM and VR scores were significantly higher than the pretreatment scores in the SH group (p=0.008 and p=0.0001). There were no significant differences between the pre-and post-treatment values of electrophysiological evaluation in N1, P2, P3 latencies or P3 amplitude (p>0.05), although there was a significant decrease in N2 latency in the post-treatment group (p=0.03).

Conclusion:

SH affects cognition in children and L-T4 replacement therapy leads to normalization of cognitive functions. Neuropsychological tests can be used as complementary measures in the evaluation of children with SH. Determining the association between ERPs and SH would contribute to the comprehensive evaluation of these children.     

An Unusual Presentation of 46,XY Pure Gonadal Dysgenesis: Spontaneous Breast Development and Menstruation

46,XY pure gonadal dysgenesis (Swyer syndrome) is characterized by normal female genitalia at birth. It usually first becomes apparent in adolescence with delayed puberty and amenorrhea. Rarely, patients can present with spontaneous breast development and/or menstruation. A fifteen-year-old girl presented to our clinic with the complaint of primary amenorrhea. On physical examination, her external genitals were completely female. Breast development and pubic hair were compatible with Tanner stage V. Hormonal evaluation revealed a hypergonadotropic state despite a normal estrogen level. Chromosome analysis revealed a 46,XY karyotype. Pelvic ultrasonography showed small gonads and a normal sized uterus for age. SRY gene expression was confirmed by multiplex polymerase chain reaction. Direct sequencing on genomic DNA did not reveal a mutation in the SRY, SF1 and WT1 genes. After the diagnosis of Swyer syndrome was made, the patient started to have spontaneous menstrual cycles and therefore failed to attend her follow-up visits. After nine months, the patient underwent diagnostic laparoscopy. Frozen examination of multiple biopsies from gonad tissues revealed gonadoblastoma. With this report, we emphasize the importance of performing karyotype analysis, which is diagnostic for Swyer syndrome, in all cases with primary or secondary amenorrhea even in the presence of normal breast development. We also suggest that normal pubertal development in patients with Swyer syndrome may be associated with the presence of a hormonally active tumor.     

Large cystic infiltrating ductal carcinoma in male breast

Cystic infiltrating ductal carcinoma is a very rare entity that, to the best of our knowledge, has not yet been reported in males. We report the sonographic and CT findings of a large cystic infiltrating ductal carcinoma in a 51-year-old man. Cystic infiltrating ductal carcinoma is a very rare entity that, to the best of our knowledge, has not yet been reported in males. We report the sonographic and CT findings of a large cystic infiltrating ductal carcinoma in a 51-year-old man.     

Computed tomography depiction of small pediatric vessels with model-based iterative reconstruction

Background

Computed tomography (CT) is extremely important in characterizing blood vessel anatomy and vascular lesions in children. Recent advances in CT reconstruction technology hold promise for improved image quality and also reductions in radiation dose. This report evaluates potential improvements in image quality for the depiction of small pediatric vessels with model-based iterative reconstruction (Veo?), a technique developed to improve image quality and reduce noise.

Objective

To evaluate Veo? as an improved method when compared to adaptive statistical iterative reconstruction (ASIR?) for the depiction of small vessels on pediatric CT.

Materials and methods

Seventeen patients (mean age: 3.4 years, range: 2 days to 10.0 years; 6 girls, 11 boys) underwent contrast-enhanced CT examinations of the chest and abdomen in this HIPAA compliant and institutional review board approved study. Raw data were reconstructed into separate image datasets using Veo? and ASIR? algorithms (GE Medical Systems, Milwaukee, WI). Four blinded radiologists subjectively evaluated image quality. The pulmonary, hepatic, splenic and renal arteries were evaluated for the length and number of branches depicted. Datasets were compared with parametric and non-parametric statistical tests.

Results

Readers stated a preference for Veo? over ASIR? images when subjectively evaluating image quality criteria for vessel definition, image noise and resolution of small anatomical structures. The mean image noise in the aorta and fat was significantly less for Veo? vs. ASIR? reconstructed images. Quantitative measurements of mean vessel lengths and number of branches vessels delineated were significantly different for Veo? and ASIR? images. Veo? consistently showed more of the vessel anatomy: longer vessel length and more branching vessels.

Conclusion

When compared to the more established adaptive statistical iterative reconstruction algorithm, model-based iterative reconstruction appears to produce superior images for depiction of small pediatric vessels on computed tomography.