Background: Changes in tendon structure are expected in chronic renal failure (CRF) due to metabolic alterations. Shear-wave elastography (SWE) is a new elastography technique that determines soft tissue elasticity noninvasively. SWE may determine early tendon degeneration due to CRF. Objectives: We aim to determine Achilles tendon thickness and elasticity in CRF patients undergoing hemodialysis with B-mode and SWE ultrasonography (US). Patients and Methods: Thirty-four (23 male, 11 female) patients with CRF and 32 healthy individuals (24 male, eight female) were included in the study. Initially both Achilles tendons of patients were evaluated for structural abnormalities or focal lesions then tendon thickness was measured with B-mode US. Tendon stiffness was measured by SWE in kilopascal (kPa) units.Results: Mean Achilles tendon thickness in the patient group was significantly lower than the control group (4.16 ± 0.59 mm vs. 4.78 ± 0.61 mm, P < 0.001). The mean elasticity scores in the patient group was 26.00 ± 9.74 kPa and 24.64 ± 6.64 kPa in the control group which was not statistically significant. Conclusion: Achilles tendon is thinner in chronic renal failure patients compared to the control group. However, there was no significant difference between the groups in stiffness values of tendons measured by SWE.

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Wallerian degeneration is the process of progressive demyelination and disintegration of the distal axonal segment following the transection of the axon or damage to the neuron. We report a case of a patient with Wallerian degeneration of the pontocerebellar tracts. She had a history of a pontine infarction 3 months ago. Wallerian degeneration of pontocerebellar tracts is seen bilaterally and symmetrically and is more visible in the middle cerebellar peduncles. Along the middle cerebellar peduncles hyperintense signal was detected on T2 weighted images. Wallerian degeneration of pontocerebellar tracts is a rare entity. It can occur bilaterally after a large pontine infarction. Magnetic resonance imaging seems to be the most effective technique for detection of Wallerian degeneration. In this report we want to mention this rare entity and to prevent wrong diagnosis.

Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.

BACKGROUND:In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS:In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS:The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION:Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

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Objective: Chronic kidney disease (CKD) is known to cause significant deterioration in the function of the testicles and sexual dysfunction in male patients who undergo hemodialysis. The aim of this study was to show the changes in the testicles that occur as a result of hypogonadism secondary to CKD and to analyze the elasticity of the parenchyma by shear wave sonoelastography. Materials and Methods:In our study we included 28 male patients who undergo dialysis three times per week and 25 healthy volunteers. Firstly, B-mode ultrasonographic evaluation was performed in both testicles for structural analysis and to detect the presence of focal lesions. Afterward, the stiffness of the parenchyma was measured in kilopascals by shear wave sonoelastography.Results: The CKD group had lower right, left, and mean testicular volumes (p<0.001). The CKD group also displayed greater right, left, and mean testicular parenchymal stiffness (p<0.001). Conclusion:CKD patients who undergo hemodialysis demonstrated significant changes in testicular size and stiffness in comparison to healthy volunteers.Keywords: Elastography, hemodialysis, renal failure, testis, ultrasonography ÖZ Amaç: Kronik Böbrek Hastalığı'nın (KBH) testis fonksiyonlarında belirgin ölçüde bozulmaya yol açtığı ve hemodiyalize giren erkek hastalarda cinsel işlev bozukluğunda belirgin bozulmaya neden olduğu bilinmektedir. Çalışmanın amacı KBH'na sekonder olarak gelişen hipogonadizm sonucu testislerde oluşan değişiklikleri ve shear-wave elastosonografi (SWE) ile testis parankiminde oluşan doku elastikiyet kaybını göstermektir.Gereç ve Yöntem: Çalışmamızda haftada 3 defa hemodiyalize giren 28 erkek hasta ve sağlıklı 25 gönüllü karşılaştırıldı. Önce B-mode ile her iki testis yapısal anormallik ve fokal lezyon varlığı açısından değerlendirildi. Ardından SWE ile testis parankim sertliği kiloPascal olarak ölçüldü.Bulgular: Kontrol grubuna göre KBH grubunun sağ, sol ve ortalama testis volümü istatistiksel anlamlı olarak daha düşüktü (p<0,001). Kontrol grubuna göre KBH grubunun sağ, sol ve ortalama doku sertliği istatistiksel anlamlı olarak daha yüksek bulundu (p<0,001).Sonuç: Hemodiyalize giren KBH'li hastalar sağlıklı gönüllülere kıyasla testis boyut ve yapısında önemli değişik-likler olduğunu göstermektedir.Anahtar Kelimeler: Elastografi, hemodiyaliz, böbrek yetmezliği, testis, ultrason Eurasian

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