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Allergic granulomatosis and angiitis in the absence of asthma and blood eosinophilia: a rare presentation of limited Churg-Strauss syndrome
(Springer Heidelberg, 2004) Sevinc, A; Hasanoglu, HC; Gokirmak, M; Yildirim, Z; Baysal, T; Mizrak, B
Allergic granulomatosis and angiitis, also known as Churg-Strauss syndrome (CSS), is an uncommon vasculitis of unknown etiology. We report a 21-year-old male patient with fatigue, dry cough, and progressive dyspnea. He had no history of asthma or eosinophilia. Thorax computed tomography showed bullous/cystic areas with thin walls in varying sizes (5-15 mm). Histopathological examination of the open lung biopsy revealed granulomatous infiltration with histiocytes and eosinophilic leukocytes. This extremely rare variant of CSS is discussed.
Atlanto-odontoid osteoarthritis in rheumatoid arthritis: dynamic CT findings
(Springer, 2004) Baysal, O; Baysal, T; Sigirci, A; Ersoy, Y; Altay, Z
We analyzed the CT appearances of degenerative change in the atlanto-odontoid joint (AOJ) in patients with rheumatoid arthritis (RA) and evaluated the effect of these changes on atlanto-axial joint (AAJ) rotation by dynamic CT. This revealed that 9 patients (24%) treated with methotrexate had degenerative features in the AOJ. The ratio of AAJ rotation to the total rotation of the cervical spine was significantly higher in normal subjects (54+/-3%) than in patients (38+/-12%). The degree of AAJ rotation was significantly lower in the patient group with degenerative features in the AOJ (20.9+/-8.4degrees) than in patients without degenerative features (28.5+/-7.4degrees). RA patients with a history of longstanding disease and treatment with antirheumatic drugs may develop AO OA. Although secondary OA was described as healing phenomena in the joints of RA patients, it can limit rotation in the AAJ and cause suboccipital neck pain. A regular check-up of the AAJ and AOJ by means of dynamic CT in all RA patients is proposed to avoid possible antirheumatic drug complications.
Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus
(Springer, 2005) Sarac, K; Akinci, A; Alkan, A; Aslan, M; Baysal, T; Özcan, C
The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9 +/- 3.4 (8.2-19.4). The average number of keto-acidosis episodes was 1.9 +/- 2.2 (0-9) and the average number of daily insulin injections was 2.8 +/- 0.97 (2-4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.
Cervical myositis ossificans traumatica: a rare location
(Springer Verlag, 1999) Baysal, T; Baysal, O; Sarac, K; Elmali, N; Kutlu, R; Ersoy, Y
An unusual case of myositis:ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.
Comparison of MRI graded cartilage and MRI based volume measurement in knee osteoarthritis
(E M H Swiss Medical Publishers Ltd, 2004) Baysal, O; Baysal, T; Alkan, A; Altay, Z; Yologlu, S
Objectives: The aim of this study was to investigate the relationship between the femoral, tibial and patellar cartilage volume and MRI grading of the articular cartilage in patients with knee OA. Methods: Articular cartilage volumes of 65 postmenopausal women were determined by processing images acquired in the sagittal plane using a fast spin echo proton density-weighted sequence. The articular cartilages were divided into 5 compartments including lateral and medial tibial, lateral and medial femoral and patellar compartments. The articular cartilages were graded using a modified Outerbridge classification. Grade 0 indicated intact cartilage, grade 1 chondral softening with normal contour, grade 2 superficial fraying, grade 3 surface irregularity and thinning and grade 4 full thickness cartilage loss. The grades of articular cartilage were compared with cartilage volume measurements. Results: In medial femoral cartilage, grade 1 had more volume compared to grade 0 cartilage (p: 0.017). In medial tibial cartilage, grade I had more volume compared to grade 0 and grade 2 cartilage (p: 0.045 and p: 0.027, respectively). In patellar cartilage, grade I cartilage had significantly more volume than grade 0 cartilage (p: 0.007). In lateral tibial and femoral cartilages, no significant difference was observed between grade 0 and grade 1 cartilage. Conclusions: Cartilage volume correlates well with MR grading of articular cartilage. The higher the grade of the cartilage the less the volume, with the exception of grade 1 lesions. Grade 1, reflects oedema in the cartilage and has a conflicting effect on volume measurement. The combination of MRI based volume measurement and grading of articular cartilage may provide an accurate method for the non-invasive evaluation and follow-up of articular cartilage.
The Crowned Dens syndrome: a rare form of calcium pyrophosphate deposition disease
(Springer Verlag, 2000) Baysal, T; Baysal, O; Kutlu, R; Karaman, I; Mizrak, B
The crowned dens syndrome has been termed as acute neck pain ascribed to CPPD deposits associated with a tomographic appearance of calcification surrounding the odontoid process. This rare entity resulting in cervical cord compression is generally seen in older female patients. We present a 26-year-old woman with cervical cord compression due to massive calcification in the periodontoid area and discuss the X-ray and CT findings of the disease.
Diffusion-weighted imaging in chronic Behcet patients with and without neurological findings
(Springer, 2005) Baysal, T; Dogan, M; Karlidag, R; Ozisik, HI; Baysal, O; Bulut, T; Sarac, K
Our aim was to investigate whether neurological impairment in chronic Behcet's disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p < 0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behcet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent.
Diffusion-weighted MR imaging of pleural fluid
(Springer, 2004) Baysal, T; Bulut, T; Gökirmak, M; Kalkan, S; Dusak, A; Dogan, M
The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm(2)) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42+/-0.76x10(-3) mm(2)/s. Exudates had a mean ADC value of 3.18+/-1.82x10(-3) mm(2)/s. The optimum cutoff point for ADC values was 3.38x10(-3) mm(2)/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements (r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.
Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis
(Wiley, 2001) Sigirci, A; Baysal, T; Kutlu, R; Aladag, M; Sarac, K; Harputluglu, H
Purpose. The purpose of this study was to evaluate the Doppler sonographic blood-flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission-phase) ulcerative colitis (UC). Methods. The IMAs and SMAs of 25 patients with active-phase UC (group 1), 19 patients with remission-phase UC (group 2), and 22 healthy, asymptomatic subjects (control group) were evaluated by duplex Doppler sonography. The 25 patients in group 1 were categorized into 2 subgroups on the basis of the extent of disease as determined by double-contrast barium enema x-ray study and colonoscopy. The first subgroup (group 1a) consisted of 11 patients with active involvement of the left colon from the rectum to the splenic flexure. The second subgroup (group 1b) consisted of 14 patients with active involvement of the entire colon. The peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (Vmean), resistance index (RI), and pulsatility index (PI) were determined from the Doppler spectral analysis. The inner diameter and cross-sectional area of the IMA and SMA were measured, and the blood-flow volume was calculated. The results were compared between the patient groups and control subjects. Results. In the IMA, the mean blood-flow volume, mean PSV, mean EDV, and Vmean were significantly higher, the mean PI was significantly lower, and the mean diameter and the mean cross-sectional area were significantly larger in group 1 than in group 2 or in the control group (p < 0.001). The mean PSV and the Vmean of the IMA were significantly higher in group la than in group Ib (p < 0.05). The mean blood-flow parameters in the SMA were not significantly different between groups 1 and 2 or between either group 1 or group 2 and the control subjects. The mean EDV in the SMA was significantly higher and the mean PI and the mean RI were significantly lower in group 1b than in group 1a (p < 0.01). Conclusions. Duplex Doppler sonography of the IMA and SMA can be used to evaluate inflammatory disease of the large bowel, to assess disease extent, and to document response to therapy. (C) 2001 John Wiley & Sons, Inc.
Early MRI findings in stab wound of the cervical spine
(Springer-Verlag, 2002) Alkan, A; Baysal, T; Saraç, K; Sigirci, A; Kutlu, R
MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings.
Early- and late-state subacute sclerosing panencephalitis: Chemical shift imaging and single-voxel MR spectroscopy
(Amer Soc Neuroradiology, 2003) Alkan, A; Sarac, K; Kutlu, R; Yakinci, C; Sigirci, A; Aslan, M; Baysal, T
BACKGROUND AND PURPOSE: Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. Our aim was to determine the metabolic abnormalities of brain in early- and late-stage SSPE by using MR spectroscopy and to assess areas of involvement in the early stages when MR imaging findings were normal. METHODS: Children with stage II (n = 3) or III (n = 3) SSPE and 10 healthy, age-matched children underwent MR imaging, multivoxel MR spectroscopy, and short-echo single-voxel MR spectroscopy (SVS). Areas of involvement in the brain were determined with chemical shift imaging. For SVS, 2 x 2 x 2-cm voxels were placed in the frontal subcortical white matter (FSWM) and parieto-occipital white matter (POWM). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (Ins)/Cr, and NAA/Cho ratios were calculated. RESULTS: Comparisons of NAA/Cr, Cho/Cr, Ins/Cr and NAA/Cho ratios between patients and control subjects showed significant differences in FSWM and POWM (P <.0l). In patients with SSPE, NAA/Cr ratios in POWM were significantly less than those in FSWM (P <.0l). NAA/Cr ratios in patients with stage II SSPE and those in the control group were not significantly different; this may reflect the absence of neuronal loss. Decreased NAA/Cr, increased Cho/Cr and Ins/Cr ratios, and increased lactate and lipid peaks were found in patients with stage III SSPE. CONCLUSION: MR spectroscopy showed findings suggestive of inflammation in stage II and findings of demyelination, gliosis, cellular necrosis, and anaerobic metabolism in stage III. MR spectroscopy could be a promising technique for early diagnosis and treatment planning in cases of SSPE.
Ectopic thymic tissue: A cause of emphysema in infants
(Elsevier Science Inc, 1999) Baysal, T; Kutlu, R; Kutlu, O; Yakinci, C; Karaman, I
Ectopic thymic tissue can present a diagnostic dilemma when it is located in the posterior mediastinum. The diagnosis can be made by awareness of it and bq use of computed tomography (CT) and magnetic resonance imaging (MRI). Rarely, ectopic thymus are reported to cause airway obstruction. In infants ectopic thymic tissue should also be considered in the differential diagnosis of secondary pneumonias and emphysema especially located in the upper lung zones. (C) Elsevier Science Inc., 1999.
En-plaque tuberculomas of tentorium in a pregnant woman
(Springer-Verlag, 2003) Alkan, A; Parlak, M; Baysal, T; Sigirci, A; Kutlu, R; Altinok, T
En-plaque tuberculoma is a rare manifestation of CNS tuberculosis and presents as a solitary, focal, caseous plaque-like lesion. It is difficult to differentiate en-plaque like meningeal tuberculoma from true primary or secondary meningeal neoplasia. Good response to antituberculosis treatment in a patient with tuberculosis history and typical MR findings confirm the diagnosis. We present the follow-up MR imaging findings of a case in which an enplaque tuberculoma on tentorium was diagnosed during pregnancy in a patient with a history of tuberculosis. To the best of our knowledge, enplaque tuberculomas of tentorium during pregnancy have not been reported before.
Environmental exposure to asbestos in eastern Turkey
(Heldref Publications, 2003) Hasanoglu, HC; Gokirmak, M; Baysal, T; Yildirim, Z; Koksal, N; Onal, Y
In this study, the authors investigated the prevalence of asbestos-related disorders among the inhabitants of Guzelyurt, a town in Malatya, located in eastern Turkey. The authors examined river bed, white soil, and stucco samples taken from various locales in Guzelyurt, and they confirmed the presence of tremolite and chrysotile asbestos fibers. Subjects (N = 920; 449 males and 471 females) were examined by photofluoroscopy. Eighty-five patients (9.2%) had asbestos-related radiological findings; risk increased with age. Calcified pleural plaques were seen more frequently in individuals greater than or equal to 50 yr of age, compared with younger subjects (p < 0.01). Asbestos-related disorders were prevalent in the inhabitants of Guzelyurt, the population of which is exposed environmentally to asbestos-primarily the result of the stuccoing and whitewashing of houses with soil that contains asbestos.
Follicular thyroid cancer presenting initially with soft tissue metastasis
(Oxford Univ Press, 2000) Sevinc, A; Buyukberber, S; Sari, R; Baysal, T; Mizrak, B
Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion. We report a case of an otherwise asymptomatic 58-year-old woman with follicular thyroid cancer who initially presented with a soft tissue mass on the right scapular region, An incisional biopsy specimen of soft tissue metastasis showed thyroid follicular neoplasm. Upon this diagnosis, the thyroid gland was re-evaluated by ultrasound, which demonstrated a solitary, hypoechoic nodule in the right lobe, Ultrasonography guided fine-needle aspiration biopsy of the thyroid nodule confirmed follicular neoplasm and the diagnosis of metastatic follicular thyroid cancer was established. The patient refused any type of treatment and left hospital against medical advice. 2.5 years later the patient was admitted to the hospital with giant, sarcoma-like multiple soft tissue masses. On this admission, the serum thyroglobulin level was extremely elevated (3500 ng/ml) and she only accepted to receive chemotherapy, Epirubicin and cyclophosphamide were administered, She received three courses of chemotherapy and is alive with a stable disease after 3 months of follow-up, This case of follicular thyroid cancer is reported because of its uncommon initial presentation with soft tissue metastasis which spread to multiple areas as giant soft tissue masses during follow-up.
Fracture healing and bone mass in rats fed on liquid diet containing ethanol
(Lippincott Williams & Wilkins, 2002) Elmali, N; Ertem, K; Ozen, S; Inan, M; Baysal, T; Güner, G; Bora, A
Background: Studies in animal models for alcohol abuse have suggested that ethanol inhibits bone growth, decreases bone formation, and increases fracture risk. Methods: Experimental tibia fracture healing in rats fed a liquid diet containing 7.2% ethanol for 8 weeks was investigated with histological and osteodensitometric studies with respect to the control group. After 4 weeks of vitamin A- and sucrose-enriched milk containing 7.2% ethanol feeding, we created closed tibia fractures, which were then fixed with intramedullary nails, in 10 rats. After a follow-up time of 4 weeks, the rats were killed for examination. The same procedure was performed in another 10 rats, which were fed on the same diet (isocaloric modified liquid diet) but without ethanol and used as the control group. A histological scoring system was developed for fracture healing. Results: Histological evaluation of fracture region revealed an average fracture healing score of 1.9 in the ethanol-fed group versus 2.6 in the control group (p = 0.014). In the test group, dual-energy x-ray absorptiometry measurements in the fracture region showed a mean bone mineral density of 0.11 +/- 0.03 g/cm(2), whereas it was 0.130 +/- 0.051 g/cm(2) in the control group (p = 0.000). The mean bone mineral content in the fracture region was 0.103 +/- 0.08 g/cm(3) in the test group versus 0.128 +/- 0.06 g/cm(3) in the control group (p = 0.000). A significant correlation was found among histological scores, bone mineral density (r = 0.64, p = 0.04), and bone mineral content (r = 0,63, p = 0.04). Conclusions: This study showed that rats fed on a diet mixed with ethanol have a histologically delayed fracture healing associated with decreased bone density and mineral content. Besides the negative effects of ethanol on bone metabolism, it also interferes with the fracture-healing process.
Giant axonal neuropathy: MRS findings
(Sage Publications Inc, 2003) Alkan, A; Kutlu, R; Sigirci, A; Baysal, T; Altinok, T; Yakinci, C
Giant axonal neuropathy (GAN) is a rare genetic disease of childhood involving the central and peripheral nervous systems. Axonal loss with several giant axons filled with neurofilaments is the main histopathological feature of peripheral nerve biopsies in this disease. Routine neuroimaging studies reveal diffuse hyperintensities in cerebral and cerebellar white matter. In this case report, the authors present the brain magnetic resonance spectroscopic features (normal N-acetylaspartate/creatine and increased choline/creatine and myoinositol/creatine ratios), which might indicate the absence of neuroaxonal loss and the presence of significant demyelination and glial proliferation in white matter, of an 11-year-old boy diagnosed with GAN.
Giant congenital nevomelanocytic nevus and intracerebral calcified lesion
(Wiley, 1996) Arisoy, AE; Akbasak, A; Oram, Y; Muftuoglu, M; Karabiber, H; Baysal, T; Arisoy, ES
[Abstract Not Available]
Glutaric aciduria type I diagnosed after poliovirus immunization: Magnetic resonance findings
(Elsevier Science Inc, 2002) Alkan, A; Baysal, T; Yakinci, C; Sigirci, A; Kutlu, R
Glutaric aciduria type I is an uncommon inborn error of metabolism. It is a serious disease, often with a fatal outcome. Magnetic resonance imaging findings and the clinical course of monozygotic twin females with glutaric aciduria type I who were admitted with acute encephalopathic crisis symptoms 3 days after immunization for poliovirus are presented in this report. Magnetic resonance imaging findings revealed hyper-intensity in the putamen, head of the left caudate nucleus, and globus pallidus, periventricular white matter (on T-2-weighted images), arachnoid cysts in bilateral temporal regions, and enlargement of the sylvian fissures. Glutaric aciduria type I should be included in the differential diagnosis of patients with acute encephalopathic crisis occurring shortly after poliovirus immunization. Typical magnetic resonance findings guide urinary organic acid analysis in these patients. (C) 2002 by Elsevier Science Inc. All rights reserved.
Lower prevalence of non-tumoral perfusion defects in left hepatic lobe during CT arterial portography with splenic artery injection
(Elsevier Sci Ireland Ltd, 2004) Kutlu, R; Akbulut, A; Sigirci, A; Alkan, A; Karaman, I; Baysal, T; Sarac, K
Objective: To determine whether there is a difference in the prevalence of non-tumoral perfusion defects (NTPD) in left hepatic lobe during CT arterial portography (CTAP) through splenic (SA) and superior mesenteric artery (SMA) injection. Methods and patients: For the preoperative evaluation, 59 patients (20 females, 39 males) who either have colorectal carcinoma metastasis (n: 42) or hepatocellular carcinoma (n: 17) underwent CTAP examination. Patients were divided, into two groups (SA and SMA) according to the injection artery. The presence and type of NTPD in the left hepatic lobe were determined and compared. Results: There were significant differences in peripherally located wedge shaped, perihilar-periligamentous and pericholecystic NTPD, but no significant difference was found in lobar/segmental defects between the groups. Conclusions: Our study demonstrated lower prevalence of NTPD in the left hepatic lobe in CTAP's performed through SA injection and we think that this could be explained by the streamlining of portal blood flow. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

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