Isolated retrovesical cyst hydatid in a child: an unusual presentation of echinococcosis

Echinococcosis is the most widespread, serious human cestode infection in the world. Isolated retrovesical cyst hydatid is extremely rare in children and mostly causes symptoms because of its pressure on adjacent organs. We report on the case of an 8-year-old girl with an isolated retrovesical cyst hydatid. Final diagnosis was established after histological examination, whereas imaging techniques failed to establish the diagnosis.     

Morphological Changes in Diseased Cementum Layers: A Scanning Electron Microscopy Study

The aim of this study was to compare the morphological changes that occurred in root cementum layers due to periodontal disease by using scanning electron microscopy (SEM). Ninety-two periodontally hopeless teeth extracted from 29 patients were studied. Measurements of probing depth (PD) and clinical attachment loss (CAL) were taken prior to extractions. After the longitudinal fracturing process of root specimens, healthy and diseased cementum layers of roots were evaluated by SEM for the thickness of the cementum and the morphological changes in collagen fibers. The result of SEM evaluation revealed a significant (P < 0.001) decrease in the thickness of cementum layer on the diseased root surfaces compared to the healthy surfaces. There were denser and conspicuous collagen fibers with their interfibrillar matrix in cementum layers on the healthy root surfaces compared to the diseased surfaces. Within the limits of this study, the thickness of cementum layers in diseased areas was found to be significantly less than that in the healthy areas of root surfaces. However, there exist variations in the density and visibility of cemental fibers between individuals and within the individual.     

A simple position to provide better imaging of upper ureteral stones close to the crista iliaca during extracorporeal shock wave lithotripsy using the Siemens Lithostar

OBJECTIVE: The fluoroscopic image from the second plan (oblique) tube of an upper ureteral stone close to the crista iliaca may be superimposed on the pelvic bones during SWL using the Siemens Lithostar with the patient in the prone position. This creates difficulty in imaging and targeting of the stone and can necessitate using ureteral catheters before treatment and/or intravenous contrast injection during SWL. We describe a very simple, yet effective method for easier visualization of the stone under this circumstance. METHODS: Between March 1992 and February 2003, we treated 1561 patients with ureteral stones by SWL with the Siemens Lithostar. The stones were localized in the upper ureter in 841. The image of the stone from the second plan (oblique) tube was superimposed on the pelvic bones in 221 in whom visualization of the stone was hardly possible with the standard prone position. By simply rotating the patient 180 degrees on the table, the superimposition of the image of the stone on the pelvic bone was obviated. This resulted in easier and better imaging of the stone during SWL. It also allowed for a clear and superior image to the treating physician during SWL. The energy and shock waves, utilization of anesthesia, number of treatment sessions, auxiliary measures, and complications were noted. Stone load was recorded in square centimeters (cm(2)). Patients were evaluated by intravenous urogram or KUB and ultrasonography when stone-free or CIRF (nonobstructive and noninfectious insignificant fragments < or =4mm) status was noted at the fluoroscopic control 2 to 4 weeks after the last session. Final CIRF decision was made 10-12 weeks after the last session. SWL was regarded as failure if no fragmentation was noted after the 3rd session. Therapy was continued if fragmentation was noted. RESULTS: The median age was 40 (range 5-85). The mean stone burden was 0.8 (range 0.24-2.9) cm(2). No indwelling ureteral stents were placed in any patients before and during treatment. The mean number of shock waves and energy used for the entire patient population was 2007 and 17.5kV, respectively. The median and average treatment session was 1 and 1.7, respectively. A total of 196 patients (89%) were rendered stone-free. Clinically insignificant residual fragments were present in 18 (8%). SWL was unsuccessful in 7 (3%) patients. These stones were removed by ureterorenoscopy. Intravenous contrast administration was not used to facilitate stone targeting during SWL. Anesthesia, in the form of analgesic sedation, was used in 7 (3%) patients. We did not observe any complications and adverse effects. CONCLUSIONS: The technique described hereby does not have an affect on coupling; it only provides a superior image of the stone to the treating physician. We advocate its application in all patients with upper ureteral stones close to the crista iliaca when the fluoroscopic image of the stone from the second plan (oblique) tube is superimposed on pelvic bones during SWL in prone position.     

Cardiac cyclic variation of integrated backscatter in hypertension and dialysis patients

BACKGROUND: Cyclic variation of myocardial-integrated backscatter (CV-IB) offers a non-invasive myocardial contractile performance assessment. There is limited data concerning CV-IB in end-stage renal disease (ESRD) patients. METHODS: Forty essential hypertensive (EH) patients (mean age 51+/-8 yrs) and 24 ESRD patients (mean age 49+/-14 yrs) were compared to 10 healthy controls (mean age 45+/-10 yrs). A 2D-Doppler echocardiography with digitized imaging was performed to characterize myocardial ultrasonic tissue by CV-IB between systole and diastole at the interventricular septum (IVS) and left ventricular (LV) posterior wall (PW). RESULTS: There was no significant difference between age and sex among groups. Systolic and diastolic blood pressures (BP) were both higher in EH patients (157/96 mmHg in EH, 129/81 mmHg in ESRD and 115/77 mmHg in controls, p<0.001). Left ventricular mass index (LVMI) was higher in EH and ESRD patients than in controls (respectively, 119+/-37, 130+/-46, 87+/-12 g/m2, p<0.05), while there was no significant difference found between EH and ESRD patients. EH patient CV-IB values were significantly lower than in ESRD patients and controls (respectively, 6.9+/-1.6, 8.6+/-0.7, 10.6+/-1.1 dB, p<0.001 for IVS, 7.7+/-1.3, 8.7+/-0.8, 10.4+/-1.1 dB, p<0.001 for PW). CV-IB for PW and IVS were significantly lower in ESRD patients than in controls (p<0.001). CONCLUSIONS: CV-IB can offer useful parameters for myocardial structure in EH and ESRD patients. Further studies are needed to clarify CV-IB in ESRD patients.     

A novel NPHS2 gene mutation in Turkish children with familial steroid-resistant nephrotic syndrome

We report in this paper two siblings aged 8 and 17 months who were clinically diagnosed with familial steroid-resistant nephrotic syndrome (SRNS). By mutation screening of the NPHS2 gene, a homozygous missense mutation, P118L, was detected in both children. This study is the first systematic investigation of NPHS2 gene mutations in Turkish children with familial SRNS. If this mutation is a hot spot of mutation in the Turkish population, screening this novel mutation in Turkish children with SRNS may be of great clinical use to prevent unnecessary treatment modalities, provide accurate genetic counselling and predict the prognosis of the disease.     

Serum insulin-like growth factor 1 and growth hormone levels of hypoxic-ischemic newborns

A number of growth factors, their binding proteins, and their receptors have been shown to be induced in the hypoxic-ischemic (HI) brain. In this prospective study, we aimed at determining the levels of insulin-like growth factor 1 (IGF-1), growth hormone (GH), and cortisol in HI babies and at identifying whether they differ from the levels of control infants. The serum IGF-1 levels were measured after the first 12-24 h of life, and the measurements were repeated on the 5th and 10th days of life for babies with HI encephalopathy (n = 18) and on the 10th day of life for controls (n = 19). Blood samples for measurement of cortisol and GH from both HI and control groups were collected after the first 12-24 h of life. There were 11 babies in the mild-to-moderate (stages I and II) group and 7 babies in the severe (stage III) group according to Sarnat and Sarnat. The IGF-1 levels of the HI group measured after 12-24 h [78.5 +/- 27.9 (range 9-123.4) ng/ml] and on the 10th day [72.2 +/- 36.8 (range 29.7-159.2) ng/ml] of life were statistically significantly lower than the IGF-1 levels of the control group [121.5 +/- 50.4 (range 74.4-280.5) ng/ml and 133.1 +/- 34.4 (range 65.9-202) ng/ml, respectively] (p = 0.002 and p = 0.001, respectively). But there was no statistically significant difference between mild-to-moderate HI group and severe HI group in terms of IGF-1 levels after 12-24 h and 5 and 10 days of life (p > 0.05). Also there was no statistically significant difference in IGF-1 values after the first 12-24 h and after 10 days of life between HI subjects who died or survived (p > 0.05). The GH levels of the HI group after the first 12-24 h of life [34.6 +/- 32.3 (range 0.1-120) mIU/l] were statistically significantly higher than those in the control group [10.4 +/- 4.5 (range 3.7-16.9) mIU/l] (p = 0.005). There was no statistically significant difference in the serum cortisol levels between HI and control groups after the first 12-24 h of life [18.7 +/- 17.0 (range 1.6-65.1) microg/dl vs. 10.8 +/- 5.4 (range 3.0-23.2) microg/dl] (p > 0.05). No statistically significant correlation was found between IGF-1 levels and GH and cortisol levels of the HI encephalopathy group [r = -0.113 (p > 0.05) and r = 0.108 (p > 0.05), respectively]. In conclusion, this study showed decreased levels of serum IGF-1 and increased levels of GH which may be secondary to serum IGF-1 influx from the circulation to the brain as a protective mechanism or may be due to some cytokines which alter the GH/IGF axis, inhibit the action of IGF-1, and stimulate IGF-binding protein 1.     

Major determinants of optic nerve head topographic characteristics in a normal Turkish population

Aim: To determine the factors affecting the topographic characteristics of the optic nerve head in a normal Turkish population. Methods: A cross‐sectional study was performed on the optic nerve head of the right eyes of 613 healthy subjects of both sexes aged 11?77 years using a confocal scanning laser ophthalmoscope. The study population was divided into three groups (<20 years, 20?50 years, and>50 years) to evaluate age‐related changes in the optic nerve head topography. A total of 15 variables were determined. Statistical analysis was performed using Student's t‐test, anova, Tukey HSD test, linear regression analysis and Pearson's correlation coefficient. Results: Four eyes were excluded from the study due to poor image quality. There were 307 female subjects and 302 male subjects. The mean age of the subjects was 42.1 ± 15.1 years. The mean optic disc areas were 1.99 ± 0.45 mm² and 1.97 ± 0.41 mm² for male and female subjects, respectively. The disc area of the subjects ranged between 1.01 and 4.19 mm². Disc area was found to be associated with all of the optic nerve head variables studied, and was also found to be significantly increased with advancing age (P < 0.05). The only variable that showed a sex‐related difference was neuroretinal rim volume, which was found to be higher in female subjects in all cases. Conclusion: Optic disc area was found to be the main determinant of the optic nerve head topography in a normal population. Optic disc area was found to be significantly increased with ageing in a normal population. These acquired changes to the optic disc could suggest stretching of the scleral ring, which may highlight the role of advancing age on the pathogenesis of glaucomatous optic neuropathy.