Publications by authors named "İbrahim Adaletli"

105 Publications

Evaluation of the relationship between ventricular function and serum growth differentiation factor-15 levels in patients with operated tetralogy of Fallot.

Cardiol Young 2021 Apr 8:1-6. Epub 2021 Apr 8.

İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Radiology, Division of Pediatric Radiology, İstanbul, Turkey.

Aim: Growth differentiation factor-15 is a novel biomarker of increasing importance in cardiovascular diseases. This study aimed to evaluate the relationship between ventricular measurements assessed by cardiac magnetic resonance imaging (MRI) and serum growth differentiation factor-15 levels in children with surgically corrected tetralogy of Fallot.

Materials And Method: Serum growth differentiation factor-15 levels were measured in 40 patients (mean age: 15.2 ± 2.9 years; 52.5% male; 87.5% NYHA I). End-diastolic volume index, end-systolic volume index, and ejection fractions of both ventricles and pulmonary regurgitation fraction were measured on cardiac MRI. The correlation between growth differentiation factor-15 levels and cardiac MRI parameters of the patients was investigated. Also, growth differentiation factor-15 levels of the patients were compared with healthy controls since reference values have not been determined in children.

Results: The mean growth differentiation factor-15 level was 254.9 ± 6.3 pg/ml in the patient group. There was no correlation between growth differentiation factor-15 levels and cardiac MRI parameters in patients. Also, there was no significant difference in growth differentiation factor-15 levels between the patients and control groups.

Conclusion: The serum levels of growth differentiation factor-15 were uncorrelated with ventricular size, function, and pulmonary regurgitation fraction assessed by cardiac MRI in children with operated tetralogy of Fallot. Moreover, growth differentiation factor-15 levels were not different in these patients from healthy children.
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http://dx.doi.org/10.1017/S1047951121001360DOI Listing
April 2021

Efficacy of tolterodine in children with overactive bladder.

Turk Pediatri Ars 2020 23;55(3):284-289. Epub 2020 Sep 23.

Department of Pediatric Nephrology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Aim: Tolterodine is an anticholinergic drug used for the treatment of overactive bladder. We evaluated the effects of tolterodine on clinical symptoms and compared its efficacy with that of oxybutynin in terms of bladder capacity, bladder wall thickness, and post-void residual volume in children with overactive bladder.

Material And Methods: Twenty-six patients who were treated with tolterodine for overactive bladder (20 girls, mean age 8.0±2.2 years) were evaluated retrospectively. Twenty patients with overactive bladder who had undergone oxybutynin treatment (15 girls, mean age 7.6±1.8 years) served as the control group. Dysfunctional voiding symptom scoring was used to evaluate the clinical response to tolterodine. To investigate the effect of treatment on the bladder, ultrasonographic data at baseline and the third month were compared with the oxybutynin group.

Results: The dysfunctional voiding symptom scores significantly decreased after the third month of tolterodine treatment (p<0.001). Bladder capacity significantly increased (p<0.001), and filled bladder wall thickness decreased (p=0.007); however, post-void residual volumes significantly increased (p<0.001) at the third month. No serious adverse effects were recorded during tolterodine treatment. The increase in bladder capacity at the third month in the tolterodine group was similar to that in the oxybutynin group (p=0.77), but the decrease in filled bladder wall thickness was significantly greater in the tolterodine group (p=0.019).

Conclusion: Tolterodine remarkably ameliorates the clinical symptoms of overactive bladder in a short time, and seems to be as effective as oxybutynin for the treatment of overactive bladder in children. Its effect on reduction of bladder wall thickness appears to be superior to that of oxybutynin.
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http://dx.doi.org/10.14744/TurkPediatriArs.2020.98215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536450PMC
September 2020

Evaluation of the thyroid disorders in children with familial Mediterranean fever.

Clin Rheumatol 2021 Apr 30;40(4):1473-1478. Epub 2020 Sep 30.

Department of Pediatric Endocrinology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Although it is well-known that autoimmune thyroid diseases are more common in most of the autoimmune connective tissue diseases, the relationship between autoinflammatory diseases and autoimmune thyroid diseases has not well-evaluated yet and still remains unclear. The aim of this study was to investigate the frequency of autoimmune diseases of the thyroid gland and to evaluate thyroid function tests in children with familial Mediterranean fever. Thyroxine, thyroid-stimulating hormone, and thyroid autoimmune markers such as thyroid peroxidase and thyroglobulin antibodies, and thyroid ultrasound findings of 133 patients with familial Mediterranean fever and 70 healthy controls were evaluated. Serum levels of thyroid-stimulating hormone, free thyroxine, and thyroid autoimmunity markers were similar in patients with familial Mediterranean fever compared with healthy controls. There was no relationship between the duration of the disease and thyroid-stimulating hormone, free thyroxine, anti-thyroid peroxidase, and anti-thyroglobulin levels. This study revealed that incidence of thyroid dysfunction and autoimmunity is not increased in patients with familial Mediterranean fever. In conclusion, routine screening of serum thyroid function tests and thyroid antibody levels is not required in patients with familial Mediterranean fever in the absence of clinical symptoms or family history. Key Points • It is well-known that autoimmune thyroid diseases are common in autoimmune diseases. • The relationship between autoimmune thyroid diseases and autoinflammatory diseases like familial Mediterranean fever is still unclear. • In this study, we report the similar frequency of the autoinflammatory thyroid diseases in patients with familial Mediterranean fever and healthy controls. • A routine screening of serum thyroid function tests and thyroid antibody levels may not be required in patients with familial Mediterranean fever in the absence of clinical symptoms or family history.
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http://dx.doi.org/10.1007/s10067-020-05430-8DOI Listing
April 2021

Evaluation of Periarticular Soft Tissues in Patients With Juvenile Idiopathic Arthritis by Superb Microvascular Imaging and Shear Wave Elastography.

Arch Rheumatol 2020 Jun 7;35(2):264-273. Epub 2020 Feb 7.

Department of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.

Objectives: This study aims to compare the vascularity and elasticity of periarticular soft tissues by superb microvascular imaging (SMI) and power Doppler (PD) ultrasound along with shear wave elastography (SWE) between children with juvenile idiopathic arthritis (JIA) and healthy children.

Patients And Methods: This prospective single center study, conducted between March 2018 and May 2018, included 22 children with JIA (14 males, 8 females; mean age 11.27±5 years; range, 5 to 17 years) and 24 healthy pediatric volunteers (12 males, 12 females; mean age 13±5.5 years; range, 7 to 17 years). Quadriceps tendon (QT), patellar tendon (PT), infraarticular and supraarticular soft tissue elasticities were calculated via SWE. Supraarticular and infraarticular soft tissue vascularity index (VI) were evaluated via SMI and PD.

Results: No significant difference was found among the mean ages of the participants in study and control groups. Mean VI of both supraarticular (8.15%) and infraarticular soft tissues (7.9%) by SMI were significantly higher in study group compared to control group (2.88% vs. 2.57%, respectively). Mean VI of both supraarticular (9.1%) and infraarticular soft tissues (8.12%) by PD were significantly higher in study group compared to control group (3.4% vs. 3.1%, respectively). Highly significant good positive correlation was found between VI values obtained with PD and SMI (r=0.9, p=0.001). There was a significant moderate positive correlation between the mean elasticity of the QT with VI of the supraarticular soft tissues by SMI (r=0.4, p=0.003). There was a significant moderate positive correlation of VI of infraarticular soft tissues by SMI with mean elasiticity of PT (r=0.42, p=0.002).

Conclusion: Vascularity index by SMI and PD could differentiate patients with JIA from healthy subjects. The SWE examination of tendons and soft tissues did not show any significant difference among patients with JIA and healthy subjects.
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http://dx.doi.org/10.46497/ArchRheumatol.2020.7640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406161PMC
June 2020

Normative values of pancreas stiffness by shear wave elastography in healthy children and adolescents.

J Med Ultrason (2001) 2020 Oct 16;47(4):583-589. Epub 2020 Jul 16.

Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul, Turkey.

Purpose: To define normal pancreas elasticity and velocity values with shear wave elastography (SWE) in healthy children and assess associations with gender, age, and body mass index (BMI).

Methods: This prospective study included a total of 100 cases (male: 50; female: 50), aged 3-17 years. Preschool, school, and adolescent periods of 3-6 years (n = 27), 7-12 years (n = 30), and 13-17 years (n = 43), respectively, were created in addition to two groups representing prepubertal and postpubertal periods of 3-10 years (n = 50) and 11-18 years (n = 50), respectively. Demographic data regarding the gender, age, height, body weight, and BMI were recorded. Pancreatic head, corpus, and tail SWE measurements were performed with a convex transducer (3.5-5 MHz). Correlations and comparisons were made for stiffness values between groups. Statistical analyses used Mann-Whitney U, Kruskal-Wallis, and Spearman's correlation tests.

Results: Medians (25-75th percentage) of age and BMI were 7 (4.25-10) years and 15 (13-17) years and 17.47 (14.94-19.23) kg/m and 21.22 (17.41-24) kg/m in the two age groups, respectively. The median (interquartile range) elasticity and velocity values for the head, corpus, and tail sections of the pancreas were measured as 9.35 (2.9) kPa and 1.76 (0.26) m/s; 9.3 (2.5) kPa and 1.74 (0.21) m/s; and 8.75 (2) kPa and 1.69 (0.15) m/s, respectively. No significant differences were identified for stiffness values between gender and pancreatic section. Pancreatic stiffness values were significantly different among two (p = 0.001) and three (p = 0.028) age groups, and presented mild positive correlations with age (r: 0.23, p: 0.002), height (r: 0.18, p: 0.01), body weight (r: 0.38, p: 0.003), and BMI (r: 0.37, p: 0.045).

Conclusion: Normal elasticity and velocity values were defined for the pancreas with SWE in children. Pancreatic stiffness does not significantly change among pancreas parts, but it increases with the transition from childhood to adolescence.
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http://dx.doi.org/10.1007/s10396-020-01039-1DOI Listing
October 2020

Normative values of thymus in healthy children; stiffness by shear wave elastography.

Diagn Interv Radiol 2020 Mar;26(2):147-152

Department of Pediatric Radiology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey.

Purpose: Thymus grows after birth, reaches maximal size after the first few years and involutes by puberty. Because of the postnatal developmental and involutional duration, we aimed toinvestigate normal stiffness values of mediastinal thymus by shear wave elastography (SWE) in different age groups of children and discuss imaging findings of thymus.

Methods: We prospectively examined 146 children (90 girls, 56 boys) who underwent a thyroid or neck ultrasound examination. All subjects underwent ultrasound and SWE evaluation of mediastinal thymus by parasternal and suprasternal approach. We subdivided the subjects based on the ages as 0 to 2 months (group 1), >2 to 6 months (group 2); >6 months to 2 years (group 3), >2 to 5 years (group 4), >5 to 8 years (group 5), and greater than 8 years old (group 6).We investigated differences of mean shear wave elasticity (kPa) and shear wave velocity (m/sec) values among age groups and the association of SWE values with age, body mass index (BMI), height, and weight of the patients.

Results: Medians and ranges of age, height, weight, and BMI were 24 (2-84) months, 85 (55-120) cm, 12(4.55-22) kg, 15.37 (13.92-17.51) kg/m2, 11 (2.64-23.15) cc, respectively. Mean shear wave elasticity of thymus when all participants were included was 6.76±1.04 kPa. Differences of mean elasticity values among age groups and also gender groups were not statistically significant. There were highly significant negative correlations among age (r:0.3), height (r:0.26), weight (r:0.3) with elasticity and also velocity values (p<0.001). The thymus elasticity is negatively correlated with age.

Conclusion: Quantitative evaluation of the thymus by SWE provides normative stiffness values based on age and gender groups. The thymus elasticity decreases with increased age, height and weight.
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http://dx.doi.org/10.5152/dir.2019.19344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051269PMC
March 2020

The Frequency of Familial Congenital Anomalies of the Kidney and Urinary Tract: Should We Screen Asymptomatic First-Degree Relatives Using Urinary Tract Ultrasonography?

Nephron 2020 7;144(4):170-175. Epub 2020 Jan 7.

Department of Pediatric Nephrology, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey.

Introduction: The objectives of this study were to determine the incidence of congenital anomalies of the kidney and urinary tract (CAKUT) in asymptomatic first-degree relatives of patients with a CAKUT diagnosis and to evaluate the benefits of such screening.

Methods: Files of patients who were followed up at Cerrahpaşa Faculty of Medicine, Pediatric Nephrology Outpatient Clinic, Istanbul University-Cerrahpaşa between 1998 and 2016 were examined retrospectively and those with CAKUT were identified. These patients, and their asymptomatic first-degree relatives, were invited to participate in this study. Ultrasonography of the urinary tract was performed in siblings and parents of 145 CAKUT patients (index cases) who could be reached by phone and agreed to participate.

Results: A total of 412 asymptomatic first-degree relatives of 145 index patients were screened by ultrasound. CAKUT was diagnosed in 23 individuals among the family members of 21 index subjects. Anomalies detected in asymptomatic first-degree relatives were renal agenesis (RA) and grade 3 hydronephrosis (n = 1), RA (n = 7), renal hypodysplasia (n = 7), grade 2 hydronephrosis (n = 1), and grade 1 hydronephrosis (n = 7). The frequency of familial CAKUT was 14.4%. Familial RA was found in 3 of the 5 families of index cases with RA.

Conclusion: The ratio of familial CAKUT was 14.4%. The findings of the present study could not support a systematic family screening to all asymptomatic first-degree relatives; however, family screening with ultrasonography can be considered for children with RA.
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http://dx.doi.org/10.1159/000505402DOI Listing
March 2021

Superb Microvascular Imaging in the Evaluation of Pediatric Graves Disease and Hashimoto Thyroiditis.

J Ultrasound Med 2020 May 9;39(5):901-909. Epub 2019 Nov 9.

Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Objectives: We aimed to investigate the differences between spectral Doppler and Superb Microvascular Imaging (SMI; Canon Medical Systems, Tokyo, Japan) findings in children with Hashimoto thyroiditis (HT) and Graves disease (GD) compared to healthy control participants.

Methods: The study included 34 patients with GD, 37 patients with HT, and 22 healthy volunteers. All patients with HT and 11 patients with GD were euthyroid; 23 patients with GD had symptoms of hyperthyroidism and had thyrotropin values of less than 0.5 mIU/L. Thyroid volumes, mean resistive indices, and peak systolic velocities along with vascularity indices (VIs) on Superb Microvascular Imaging were measured.

Results: Patients with GD had a significantly higher mean thyroid volume (P < .001; right lobe, 11.80 mL; left lobe, 9.10 mL) and peak systolic velocity (right, 32.5 cm/s; left, 30 cm/s) with a lower resistive index (right, 0.48%; left, 0.48%) compared to patients with HT (right, 8.78 mL, 20 cm/s, 0.55%; left, 7.41 mL, 20 cm/s, 0.55%, respectively) and also control participants (right, 4.59 mL, 15 cm/s, 0.56%; left, 3.52 mL, 15 cm/s, 0.54%). Patients with GD had a significantly higher median VI (right, 25%; left, 26%) compared to patients with HT (right, 11%; left, 13%) and control participants (right, 8%; left, 8%). When patients with GD were categorized as euthyroid and hyperthyroid based on thyrotropin levels and clinical symptoms, both euthyroid and hyperthyroid patients with GD had significantly higher thyroid volumes compared to patients with HT (P < .001). Hyperthyroid patients with GD had higher thyroid volumes compared to euthyroid patients with GD; however, the difference failed to reach statistical significance. A significant strong positive correlation with the VI and thyrotropin receptor autoantibody levels (r = 0.696) was found. The highest area under the curve was obtained for the right lobe VI (0.885), followed by the left lobe VI (0.872), right lobe volume (0.828), and peak systolic velocity (0.810). The optimal cutoff VI value for distinguishing between HT and GD was 17.35% with sensitivity, specificity, and diagnostic accuracy of 85.3%, 78.4%, and 81.7%, respectively.

Conclusions: Superb Microvascular Imaging is a new method that can detect subtle vascularity changes with higher accuracy compared to spectral Doppler parameters in distinguishing between HT and GD.
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http://dx.doi.org/10.1002/jum.15171DOI Listing
May 2020

Prenatal Diagnosis of 5p Deletion Syndrome with Brain Abnormalities by Ultrasonography and Fetal Magnetic Resonance Imaging: A Case Report.

Fetal Pediatr Pathol 2020 Oct 25;39(5):446-451. Epub 2019 Sep 25.

Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey.

5p deletion syndrome commonly known as cri du chat syndrome is a well-described syndrome in neonates with catlike cry, craniofacial dysmorphic features, abnormal dermatoglyphics, microcephaly and severe psychomotor and developmental delay. We report a case of 5p deletion syndrome diagnosed prenatally in association with mild ventriculomegaly, cerebellar hypoplasia, pontine hypoplasia, increased subarachnoid space and high suspicion of cortical hypoplasia with ultrasound, magnetic resonance imaging, and postmortem examination. Best to our knowledge, this is the first case that pontine hypoplasia and increased subarachnoid space have been demonstrated prenatally and confirmed by postnatal autopsy.
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http://dx.doi.org/10.1080/15513815.2019.1669230DOI Listing
October 2020

Superb Microvascular Imaging Compared With Power Doppler Ultrasound in Assessing Synovitis of the Knee in Juvenile Idiopathic Arthritis: A Preliminary Study.

J Ultrasound Med 2020 Jan 20;39(1):99-106. Epub 2019 Jun 20.

Department of Pediatrics, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, KMPasa, Istanbul, Turkey.

Objectives: To investigate the efficiency of Superb Microvascular Imaging (SMI; Toshiba Medical Systems, Tustin, CA) in assessing inflammation of the synovium in the knee of patients with juvenile idiopathic arthritis (JIA) compared with power Doppler ultrasound (PDUS).

Methods: Both knees of patients with a diagnosis of clinically active JIA were examined with grayscale ultrasound (US). The knees with positive US and physical examination findings were included in group A, whereas the knees with positive US findings despite negative physical examination findings were included in group B. The observers calculated the vascularity index (VI) by manually drawing a region of interest onto the thickest part of the synovium using PDUS and SMI.

Results: The median SMI VI (observer 1, 4.9% [interquartile range (IQR), 3.6%]; observer 2, 4.1% [IQR, 4.6%]) exceeded the median PDUS VI (observer 1, 1.5% [IQR, 1.8%]; observer 2, 1.5 [IQR, 1.9%]; P < .0001). In group B, the median SMI VI (observer 1, 2.85% [IQR, 8%]; observer 2, 3.1% [IQR, 6.3%]) exceeded the median PDUS VI (observer 1, 0.5% [IQR, 2%]; observer 2, 0.55% [IQR, 2.3%]; P = .002 and .001 for observers 1 and 2, respectively). No significant differences were observed between groups concerning the PDUS VI and SMI VI (P > .05).

Conclusions: Superb Microvascular Imaging was superior to PDUS in depicting blood flow in the hypertrophied synovial tissue in the knee of patients with clinically active JIA. Superb Microvascular Imaging seems to a promising tool and a valuable adjunct to conventional US in assessing inflammation of the synovial tissue in patients with JIA.
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http://dx.doi.org/10.1002/jum.15079DOI Listing
January 2020

Comparative evaluation of liver, spleen, and kidney stiffness in HIV-monoinfected pediatric patients via shear wave elastography

Turk J Med Sci 2019 06 18;49(3):899-906. Epub 2019 Jun 18.

Department of Pediatric Radiology, Faculty of Medicine, İstanbul University, İstanbul, Turkey

Background/aim: This study aimed to evaluate the stiffness of the liver, spleen, and kidneys in HIV-monoinfected children via shear wave elastography (SWE).

Materials And Methods: Twenty-one HIV-monoinfected children and 37 healthy subjects were included in this study. Livers, spleens, and kidneys of the participants were examined via ultrasound and SWE. Patients were divided into two groups according to the presence of pathologic ultrasonographic findings. Routine laboratory tests were also recorded. Stiffness of these organs was compared between patients and control groups.

Results: Liver transaminases, blood urea, and creatinine levels were normal in all subjects. Ultrasonographic examination revealed hepatosplenomegaly (n = 1, 4.7%), grade 1 hepatosteatosis (n = 1, 4.7%), and hepatosteatosis and minimal heterogeneity of the liver (n = 1, 4.7%). Ultrasonographic features were normal in 18 patients. Stiffness of the liver, spleen, and kidneys of all HIV-monoinfected children with normal laboratory parameters was significantly higher than in healthy subjects. Eighteen patients with normal ultrasonographic findings also had higher stiffness values when compared to control subjects.

Conclusion: Stiffness of the liver, spleen, and kidneys in HIV-monoinfected children was increased. SWE can be used in the detection of early parenchymal changes even in patients with normal laboratory parameters and ultrasonographic findings.
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http://dx.doi.org/10.3906/sag-1811-87DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018312PMC
June 2019

An unusual presentation of sixth nerve palsy: neurobrucellosis.

GMS Ophthalmol Cases 2019 4;9:Doc13. Epub 2019 Apr 4.

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Abducens nerve palsy is generally seen in older patients with diabetes and hypertension. It is relatively rare in young and otherwise healthy patients. An extensive differential diagnosis is considered in patients younger than 50 years of age who develop a sixth nerve palsy. We report here a 25-year-old patient from Turkey who was admitted with sixth nerve palsy as a component of neurobrucellosis. She was referred to our clinic because she had double vision and restricted right eye abduction. During the ophthalmic examination, both pupils were round and reactive to light and accommodation. Extraocular movements were intact with the exception that the right eye was unable to abduct. Magnetic resonance imaging revealed no pathology. She also had a diagnosis of brucellosis and her abducens nerve palsy was a form of clinical manifestation of neurobrucellosis. We conclude that neurobrucellosis should be considered in patients with sixth cranial nerve palsy especially in areas where brucellosis is endemic.
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http://dx.doi.org/10.3205/oc000102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533445PMC
April 2019

Effects of static stretching duration on muscle stiffness and blood flow in the rectus femoris in adolescents.

Med Ultrason 2019 May;21(2):136-143

Department of Pediatric Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey.

Aims: To compare the effects of 2 and 5 min of passive static stretching (SS) on stiffness and blood flow in the rectus femoris in adolescent athletes using shear wave elastography (SWE) and superb microvascular imaging (SMI).Material and methods: This prospective study included 20 male athletes with median age of 14.5 (12.5-16.5) years. The subjects were divided into two groups based on the SS duration as follows: 2 min (n=10) and 5 min (n=10). At rest and after 2 and 5 min of SS, stiffness and blood flow values were compared in the rectus femoris for each group. Inter-operator reliability was also analysed.

Results: There was no significant difference between resting and 2 min of SS in terms of stiffness. The stiffness values decreased significantly from resting to 5 min of SS. The blood flow increased significantly from resting to 2 and 5 min of SS. Inter-operator reliability was moderate to perfect for SWE and SMI measurements (ICC: 0.52-0.83).

Conclusions:  SWE and SMI can be used to acquire reliable quantitative data about muscle stiffness and blood flow in adolescents. While stiffness parameters significantly decreased from resting after only 5 min, blood flow significantly increased both after 2 and 5 min. For physical rehabilitation protocols, 5 min of SS may be chosen to reduce stiffness. For competitions, 2 min of SS may be sufficient for warm-up exercise because it increases the blood flow optimally. Five min of SS may be preferred for the cool-down exercise to enhance recovery.
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http://dx.doi.org/10.11152/mu-1859DOI Listing
May 2019

Multi-parametric Ultrasound Evaluation of Pediatric Thyroid Dyshormonogenesis.

Ultrasound Med Biol 2019 07 25;45(7):1644-1653. Epub 2019 Apr 25.

Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey.

The aim of this study was to assess the diagnostic contribution of gray-scale ultrasonography, color Doppler, superb microvascular imaging and shear wave elastography in thyroid dyshormonogenesis (TD). From October 2017 to February 2018, the prospective study included 31 patients (13.6 y; 11-14 y) diagnosed with TD based on thyroid scintigraphy and perchlorate discharge tests and 40 healthy pediatric volunteers (12.8 y; 10-16 y). Median resistive indices (RIs), peak systolic and end-diastolic velocities, vascularity indices (VIs) via superb microvascular imaging and shear wave elastography parameters were evaluated. Median VI values were significantly higher and median RI values were significantly lower in the study group than the control group. No significant difference was found between shear wave elastography parameters of the TD and control group. VI was significantly correlated with median total thyroid gland volumes (p = 0.002, r = 0.28), medication dosage (p = 0.03, r = 0.48) and 2-h radioactive iodine uptake values (p = 0.008, r = 0.57). VI is a clinically significant and novel parameter useful for diagnosing TD.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2019.03.004DOI Listing
July 2019

Echogenic lymph nodes in the differential diagnosis of pediatric sarcoidosis.

J Med Ultrason (2001) 2019 Apr 8;46(2):277-281. Epub 2019 Feb 8.

Pediatric Rheumatology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

We present a delayed diagnosis of sarcoidosis in an 11-year-old girl by demonstrating ultrasonographic imaging findings of granulomatous cervical and abdominal lymph node involvement. Pulmonary interstitial fibrosis in addition to multi-compartmental enlarged echogenic lymph nodes could be considered sarcoidosis. Punctate echogenic foci in the cervical lymph nodes should be considered in the differential diagnosis of sarcoidosis.
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http://dx.doi.org/10.1007/s10396-019-00932-8DOI Listing
April 2019

Hepatosplenic Fungal Infections in Children With Leukemia-Risk Factors and Outcome: A Multicentric Study.

J Pediatr Hematol Oncol 2019 May;41(4):256-260

Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa.

Background: Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment.

Procedure: In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers.

Results: All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals.

Conclusions: Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms.
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http://dx.doi.org/10.1097/MPH.0000000000001431DOI Listing
May 2019

Primary Rhabdomyosarcoma of the Breast: Imaging Findings and Literature Review.

Breast Care (Basel) 2018 Aug 22;13(4):293-297. Epub 2018 May 22.

Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

Background: Primary breast rhabdomyosarcoma (RMS) can occur in children. There is a lack of knowledge regarding radiologic findings and added diffusion-weighted magnetic resonance imaging (MRI) features of RMS in the literature.

Case Report: A 12-year-old girl was diagnosed with primary alveolar RMS of the breast. Gray scale ultrasound revealed posterior acoustic enhancement behind a well-circumscribed, multilobulated hypoechoic mass. Doppler ultrasound revealed increased peripheral and central vascularity. Hypointense septations on T2-weighted image exhibiting more enhancement than the stroma on late gadolinium-enhanced images were striking within a hyperintense mass. A hyperintense hemorrhagic focus on T1-weighted image was present in the absence of any necrosis. Avid enhancement on early postcontrast images proceeding from the periphery to the center was depicted.

Conclusion: A rapidly enlarging mass with an echogenic peripheral rim together with posterior acoustic enhancement on gray scale ultrasound, intense vascularity on Doppler ultrasound, axillary lymphadenopathy, and satellite nodules on MRI should raise suspicion. Enhancing central and peripheral septations are suggestive of RMS. Dynamic contrast-enhanced MRI in suspected cases can provide valuable data in the differential diagnosis.
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http://dx.doi.org/10.1159/000487750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167649PMC
August 2018

Quantitative Assessment of Palatine Tonsils in Healthy Children and Adolescents With Shear-Wave Elastography.

Ultrasound Q 2018 Dec;34(4):213-218

Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

The normal elasticity and velocity values for palatine tonsils (PTs) in healthy children and adolescents were defined using shear wave elastography, and the relationship with potential factors affecting these values was assessed. This prospective study included a total of 80 cases with ages ranging from 3 to 17 years. Sex, age, and body mass index (BMI) were recorded. Elasticity and velocity measurements of both PTs and the relationship with basic descriptive data were investigated. For statistical analyses, independent-samples t tests and Spearman ρ (r) correlation coefficient were used. Quantitative variables are shown as the mean ± SD, and categorical variables are shown as n (%). The mean age was 10.6 ± 6.4 years, and the mean BMI was 17.40 ± 4 kg/m. The mean elasticity and velocity values were 9.38 ± 1.27 kPa and 1.76 ± 0.11 m/s for the right PT and 9.57 ± 1.43 kPa and 1.79 ± 1.04 m/s for the left PT, respectively. The mean tonsil volume was 2.44 mL for the right PT and 2.36 mL for the left PT. There were no significant differences in elasticity, velocity, and volumes when comparing location, age, or sex groups. No significant correlations were observed between the elasticity and velocity values and BMI. In conclusion, this preliminary work can be used as a reference for the diagnosis of PT diseases. Future comprehensive studies are necessary to establish the role of elastography in the diagnosis of pathologic tissue differentiation confirmed by clinical, laboratory, or pathology analyses.
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http://dx.doi.org/10.1097/RUQ.0000000000000388DOI Listing
December 2018

Shear wave elastography of parotid glands in pediatric patients with HIV infection.

Radiol Med 2019 Feb 26;124(2):126-131. Epub 2018 Sep 26.

Department of Pediatric Infectious Diseases, Istanbul University Faculty of Medicine, Turgut Ozal Street, No: 118, 34093, Fatih, Istanbul, Turkey.

Objectives: Parotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.

Materials And Methods: This single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann-Whitney U test were used in statistical analysis.

Results: Stiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.

Conclusions: PG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner.
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http://dx.doi.org/10.1007/s11547-018-0945-9DOI Listing
February 2019

Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux.

J Ultrasound Med 2019 Feb 19;38(2):379-385. Epub 2018 Jul 19.

Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Objectives: To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux.

Methods: We prospectively evaluated 49 patients with unilateral grade 2 or higher-degree VUR. All patients underwent dimercaptosuccinic acid (DMSA) scintigraphy for evaluation of the renal parenchymal scar. After the DMSA scan, 2 radiologists, who were blinded to clinical data and each other's measurements, evaluated the kidneys of the patients using SWE. The kidneys were divided into 3 parts: upper pole, middle region, and lower pole, and 3 regions of interest were placed to each part. Shear wave velocity (SWV) values were calculated using meters per second as a unit and recorded for each region. Afterward, SWV values were compared to DMSA results.

Results: There was no significant difference between the observers' mean SWV values of kidneys with VUR without scar formation (mean ± SD, 2.11 ± 0.06 and 2.09 ± 0.05 m/s) and the contralateral normal kidney SVW values (2.11 ± 0.06 and 2.10 ± 0.05 m/s; P = .936 and .724, respectively). We observed a significant difference between the mean SWV values of the kidneys with VUR accompanied by scar formation (2.28 ± 0.10 and 2.27 ± 0.11 m/s) and the mean SWV values of the contralateral normal kidneys (2.09 ± 0.05 and 2.10 ± 0.04 m/s; P < .001 for both observers).

Conclusions: Shear wave elastography could detect scar tissue in kidneys; however, the variability of the stiffness due to the kidney's complex structure, and variations in blood perfusion and the glomerular filtration rate of the kidney might limit the use of SWE in current clinical diagnostic algorithms for VUR.
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http://dx.doi.org/10.1002/jum.14698DOI Listing
February 2019

Severe Multisystem Involvement of Chronic Granulomatous Disease in a Pediatric Patient.

J Trop Pediatr 2019 Apr;65(2):192-195

Pediatric Infectious Diseases Department, Istanbul Medical Faculty, Istanbul University, Capa/Fatih, Istanbul 34098, Turkey.

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disorder identified by recurrent pyogenic and fungal infections infections secondary to defective nicotinamide adenine dinucleotide phosphate oxidase enzyme. In the present study, we demonstrated a case with a history of multiple segmental lung resections because of invasive bronchopulmonary aspergillosis, multifocal hepatic and splenic granulomas, bilateral adnexal calcific foci presumed to be related with old granulomatous infection and finally gastric outlet obstruction secondary to the involvement of the stomach wall thickening with granulomatous tissue. This is an extremely severe case of CGD with multiorgan involvement within a 10-year period after the diagnosis. Gastric antral involvement may mimic inflammatory bowel diseases in such cases, and intestinal involvement can reliably be demonstrated via ultrasonography. Spontaneous resolution of the antral involvement was observed in the follow-up.
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http://dx.doi.org/10.1093/tropej/fmy022DOI Listing
April 2019

Evaluation of parotid glands in healthy children and adolescents using shear wave elastography and superb microvascular imaging.

Radiol Med 2018 Sep 30;123(9):710-718. Epub 2018 Apr 30.

Department of Pediatric Radiology, Istanbul Faculty of Medicine, Turgut Ozal Street, Fatih, 34063, Istanbul, Turkey.

Objectives: We aim to determine parotid gland elasticity values from healthy children and adolescents using shear wave elastography (SWE). We also define the degree of vascularity using superb microvascular imaging (SMI), power Doppler (PD), and color Doppler (CD) and compare SMI with CD and PD.

Materials And Methods: A total of 100 cases, comprising 50 girls and 50 boys, with ages ranging from 3 to 17 years were included in this prospective study. SWE, SMI, PD, and CD measurements were taken from both parotid glands, and the relationships with sex, age, and body mass index (BMI) were determined. The SMI was compared with the PD and CD.

Results: The median elasticity values measured with SWE were 8.37 ± 2.09 kPa and 1.68 ± 0.26 m/s on the right and 8.33 ± 2.04 kPa and 1.69 ± 0.26 m/s on the left. There were significant positive correlations present for those aged below and above 10 years and for BMI with elasticity values. The median vascular spot numbers measured using SMI, PD, and CD were 5 ± 1.70, 3.5 ± 1.45, and 2 ± 1.1 on the right and 4 ± 1.7, 4 ± 1.43, and 2 ± 1.05 on the left, respectively. The median values obtained with SMI were significantly higher than the median values obtained with both PD and CD.

Conclusion: This study determined the reference SWE, SMI, PD, and CD values for normal parotid glands in healthy children and adolescents. Elasticity values were affected by age and BMI. There was no correlation between vascularity values and age, sex, or BMI. SMI provided more detailed information about vascularity compared with the other methods.
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http://dx.doi.org/10.1007/s11547-018-0897-0DOI Listing
September 2018

Giant Renal Hemangioma in an Adolescent Girl: A Very Rare Entity.

Urology 2018 Aug 17;118:198-201. Epub 2018 Apr 17.

Department of Urology, Division of Pediatric Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.

Hemangiomas are benign vascular tumors of childhood and they usually tend to be located in the upper parts of the body (head and neck). However, renal hemangiomas are very rare and usually occur to be small (1-2 cm) in size. Here, we report an adolescent girl with a giant renal hemangioma of 15 cm diameter.
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http://dx.doi.org/10.1016/j.urology.2018.04.005DOI Listing
August 2018

Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph nodes categorization: a comparative study.

Br J Radiol 2018 Jul 11;91(1087):20180129. Epub 2018 May 11.

1 Department of Radiology, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey.

Objective: To determine the diagnostic utility of a vascularity index via superb microvascular imaging in lymph nodes of children with malignant lymphoma and acute lymphadenitis compared to normal lymph nodes.

Methods: We performed a retrospective study for multiparametric lymph node (LN) evaluation. Malignant lymphoma diagnosed via histopathological examination and lymph nodes receiving an acute lymphadenitis diagnosis based on clinical and laboratory findings constituted the study subgroups. We calculated a shape index [SI (percent of shortest to longest diameter)] using grayscale ultrasonography and elasticity and velocity values via shear wave elastography (SWE) as well as a vascularity index (VI) using superb microvascular imaging (SMI) for comparison with normal lymph nodes.

Results: 45 lymph nodes diagnosed with malignant lymphoma, 72 lymph nodes diagnosed with acute lymphadenitis and 146 normal lymph nodes were evaluated. For differentiating lymphoma from normal lymph nodes, vascularity index cut-off values higher than 15% represented a diagnostic accuracy of 95%; cut-off elasticity values higher than 17 kPa exhibited a diagnostic accuracy of 99%. Optimal VI, elasticity, velocity and SI cut-off values in differentiating lymphoma from lymphadenitis were 15%, 17 kPa, 2.45 m sn (p < 0.001) and 65% (p < 0.002) with calculated diagnostic accuracies of 83, 87, 88 and 68%, respectively.

Conclusion: Vascularity index values obtained via superb microvascular imaging and SWE would be reasonably useful in differentiating malignant lymphoma and acute lymphadenitis from normal LNs. SWE would be more efficient in distinguishing malignant lymph nodes from acute lymphadenitis compared with superb microvascular imaging. Advances in knowledge: Vascularity index by superb microvascular imaging would be a novel Doppler parameter in differentiating both lymphoma from lymphadenitis and also lymphadenitis from normal lymph nodes.
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http://dx.doi.org/10.1259/bjr.20180129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221772PMC
July 2018

Superb Microvascular Imaging of Palatine Tonsils in Healthy Children: A Preliminary Study.

Ultrasound Q 2018 Jun;34(2):71-76

Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul, Turkey.

In healthy children, the normal vascularity index (VI) values were defined for palatine tonsils using the superb microvascular imaging (SMI), and the relationship with potential factors affecting these values was assessed. This prospective study evaluated 74 children (age range = 3-17 years, median = 13 years, SD = 6.4 years). The cases were divided into 3 subgroups based on age as 3 to 6 years (preschool), 7 to 12 years (school age), and 13 to 17 years (adolescent). Demographic data such as sex, age, and body mass index (BMI) were recorded. The VI values of tonsils were measured with SMI and power Doppler (PD), and the correlation with descriptive data was researched. The Student t test, Mann-Whitney U test, and Spearman ρ correlation coefficient were used. The mean VI values on the right tonsil were calculated as 7.5% and 2.6% and on the left tonsil were 6.5% and 2.3% according to SMI and PD, respectively. On SMI, the vascularity was similar in the preschool and school-age groups, with a significant reduction between the school-age and adolescent groups. As BMI increased, tonsil vascularity reduced on SMI and PD. There was no significant difference in tonsil vascularity between the sexes. The VI values were identified to be higher on SMI compared with PD (P = 0.001). In healthy children, the normal VI values for both tonsils were determined with SMI and PD. On SMI, tonsil vascularity reduced significantly in the transition from school age to adolescence. Tonsil vascularity was affected by variations in BMI.
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http://dx.doi.org/10.1097/RUQ.0000000000000351DOI Listing
June 2018

Quantitative Assessment of Thyroid, Submandibular, and Parotid Glands Elasticity With Shear-Wave Elastography in Children.

Ultrasound Q 2018 Jun;34(2):58-61

Department of Radiology and.

Tissue elasticity is becoming a more commonly used parameter in evaluation of parenchyma in inflammatory diseases. Considering the changes in the thyroid and salivary glands with adolescence, determination of mean elasticity ranges with a function of age is necessary to apply ultrasound elastography more widely in the pediatric population.The thyroid, submandibular, and parotid glands of 127 healthy volunteers (66 males, 61 females; mean age = 10.3 ± 3.9 years; range = 3-17 years) were evaluated with shear-wave elastography.The mean elasticity values for the thyroid, submandibular, and parotid glands were 14.6 ± 3.3, 11.8 ± 2.2, and 11.8 ± 2.6 kPa, respectively. There was a significant positive correlation between age and elasticity of the thyroid, submandibular, and parotid glands. There was a significant correlation between age and elasticity value of the thyroid gland adjusted for weight and height.This study provided the baseline quantitative elasticity measures of thyroid, submandibular, and parotid glands, which would be a reference for upcoming studies. In addition, an increase in elasticity value in thyroid gland as a function of age independent of change in weight and height was demonstrated.
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http://dx.doi.org/10.1097/RUQ.0000000000000352DOI Listing
June 2018

Utility of lung radiodensity ratios in diagnosis of radiolucent foreign body aspiration in children: a practical approach.

Clin Imaging 2019 Mar - Apr;54:178-182. Epub 2018 Mar 4.

Istanbul Faculty of Medicine, Department of Radiology, Turgut Ozal Caddesi 118, Fatih, İstanbul, Turkey.

Objective: To evaluate the utility of radiodensity ratio between lungs on chest X-ray for the diagnosis of radiolucent foreign body aspiration (FBA) in children.

Methods: X-rays of 33 patients with confirmed diagnosis of FBA by bronchoscopy were compared to 66 control patients. We divided the study group into three subgroups: symmetric (13-patients), right-oblique (RO;12-patients) and left-oblique (LO;8-patients).

Results: When we compared FBA-symmetric-subgroup to symmetric-control-group, FBA-RO-subgroup to RO-control-group and FBA-LO-subgroup to LO-control-group, radiodensity ratios were significantly higher in the FBA subgroups.

Conclusion: The calculated radiodensity ratio between lungs on X-ray would be a useful and practical tool for the diagnosis of radiolucent FBA in children.
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http://dx.doi.org/10.1016/j.clinimag.2018.03.005DOI Listing
May 2019

Unilateral rapid enlargement of an adolescent breast: pseudoangiomatous stromal hyperplasia in a giant juvenile fibroadenoma.

Breast J 2018 07 8;24(4):648-649. Epub 2018 Mar 8.

Istanbul Medical Faculty, Department of Radiology, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/tbj.13030DOI Listing
July 2018

A rare cause of vomiting: annular pancreas.

Turk Pediatri Ars 2017 Dec 1;52(4):236-239. Epub 2017 Dec 1.

Istanbul University, Cerrahpaşa Medical Faculty, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul, Turkey.

Annular pancreas is a rare congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the second part of the duodenum. It can affect anyone from neonates to adults, and is difficult to diagnose because it can present in a wide range of clinical conditions. Although cases have also been reported in adults, symptomatic cases are often referred in infancy or early childhood. A 17-year-old female patient who was diagnosed as having annular pancreas is reported. The patient had had non-bilious vomiting accompanied by abdominal pain, especially 5-10 minutes after meals, for seven years. Annular pancreas, which may be seen at any age, should be considered in the differential diagnosis of patients with non-bilious vomiting, particularly after meals, over a long period.
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http://dx.doi.org/10.5152/TurkPediatriArs.2017.3394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819863PMC
December 2017

A Rare Cause of Paraplegia: Myeloid Sarcoma

Turk J Haematol 2018 08 2;35(3):206-207. Epub 2018 Feb 2.

University of Health Sciences, Kanuni Sultan Süleyman Traning and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey

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http://dx.doi.org/10.4274/tjh.2017.0423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110446PMC
August 2018