The aim of our study was to compare non-contrast spiral CT, US and intravenous urography (IVU) in the evaluation of patients with renal colic for the diagnosis of ureteral calculi. During a period of 17 months, 112 patients with renal colic were examined with spiral CT, US and IVU. Fifteen patients were lost to follow-up and excluded. The remaining 97 patients were defined to be either true positive or negative for ureterolithiasis based on the follow-up data. Sensitivity, specificity, positive and negative predictive value and accuracy of spiral CT, US and IVU were determined, and secondary signs of ureteral stones and other pathologies causing renal colic detected with these modalities were noted. Of 97 patients, 64 were confirmed to have ureteral calculi based on stone recovery or urological interventions. Thirty-three patients were proved not to have ureteral calculi based on failure to recover a stone and diagnoses unrelated to ureterolithiasis. Spiral CT was found to be the best modality for depicting ureteral stones with a sensitivity of 94 % and a specificity of 97 %. For US and IVU, these figures were 19, 97, 52, and 94 %, respectively. Spiral CT is superior to US and IVU in the demonstration of ureteral calculi in patients with renal colic, but because of its high cost, higher radiation dose and high workload, it should be reserved for cases where US and IVU do not show the cause of symptoms.

The aim of this study was to investigate the prevalence, predictors and radiological findings of primary Sjögren's syndrome (pSS)-associated lung involvement. This retrospective cohort study included 123 patients with demographic, clinical, laboratory and radiological data who were diagnosed with pSS. Lung involvement was defined based on the presence of pulmonary signs/symptoms and/or impaired pulmonary function tests along with alterations in high-resolution computerized tomography (HRCT). Thirty patients (24.4%) had pulmonary signs/symptoms at the initial presentation and/or during the follow-up period. Based on the criteria, 14 patients (11.4%) were defined as having pSS with lung involvement. The smoking rate, male/female ratio and the mean ages were found to be higher in patients with lung involvement (P < 0.05). Positive IgM-rheumatoid factor (RF), anti-La and anti-Ro results, the presence of hypergammaglobulinemia and lymphopenia had high specificity despite the low sensitivity rates to detect pSS-associated lung disease. A significant difference was found in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) results between the patients with and without lung involvement. Impaired FEV(1) had high specificity and positive predictive value compared to impaired FVC, particularly in non-smoker patients. The most frequent HRCT finding was ground-glass attenuation (64.3%). Other common findings were bronchiectasis, reticular pattern and honeycombing. The lesions involved predominantly the lower lobes. In conclusion, the presence of hypergammaglobulinemia and lymphopenia, positivity for RF, anti-La and anti-Ro, and impaired (FVC) and/or FEV(1) values could be the predictive parameters with a high specificity despite the low sensitivity rates. Smoking history, male gender and age are also risk factors. These parameters may be helpful to distinguish pSS-associated lung involvement from lung disorders unrelated to pSS.

Most patients with fascioliasis have typical hepatobiliary imaging findings. It is important to know that residual fibrotic or necrotic foci may remain for years after cure. Long-term complications are rare in fascioliasis, and malignancy or cirrhosis related to the disease has not been observed.

We studied the role of duplex Doppler ultrasonography in the diagnosis of renal obstruction caused by ureteral calculi. Using duplex Doppler sonography, we evaluated the intrarenal hemodynamics of 27 patients who presented to the emergency department with renal colic. We performed Doppler ultrasonography on patients in whom US did not reveal any pathology causing renal colic and calculated and compared mean RI values of normal and obstructed kidneys and DeltaRI values of each group. Threshold levels for the diagnosis of urinary tract obstruction (mean RI > or = 0.70 and DeltaRI > or = 0.08) were used to determine the sensitivity and specificity of Doppler sonography for the diagnosis of urinary tract obstruction. Patients were investigated for revealing calculi diagnosis either by stone excretion history, intravenous pyelography or non contrast enhanced urinary computed tomography. A total of 162 intrarenal arterial Doppler recordings were made on 54 kidneys. Of the 16 patients with urinary obstruction, 11 (68%) had sonographic evidence of pelvicalyceal dilatation. The mean RI of the 16 obstructed and 11 unobstructed kidneys was 0.69 +/- 0.04 and 0.61 +/- 0.06 (mean +/- standard deviation), respectively. The difference between the mean RI values for each group was statistically significant (P < 0.05). Mean RI values of the contralateral kidneys in the obstructed group and unobstructed group were 0.61 +/- 0.03 and 0.59 +/- 0.05, respectively. Also DeltaRI value (0.07 +/- 0.02) of obstructed kidney group was statistically higher than the DeltaRI value (0.01 +/- 0.03) of the unobstructed group (P < 0.05). The mean RI of the 16 obstructed kidneys (0.69 +/- 0.04) was significantly greater than that of the 16 unobstructed contralateral kidneys (0.61 +/- 0.03) (P < 0.05). This study supplements the existing evidence that, in acutely obstructed kidneys, renal Doppler recording can demonstrate altered renal perfusion before pelvicalyceal system dilatation and distinguish obstructed and unobstructed kidneys evaluated with suspicion of renal colic.

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A. fl avus , A. tamari and A. alliaceus . A. fl avus is a member of A. fl avus clade, whereas Aspergillus alliaceus andPetromyces albertensis together with Aspergillus lanosus are assigned to A. alliaceus clade [8]. Although human infections caused by A. alliaceus are rare, this species has been previously isolated from a case of chronic otitis externa after surgery [9]. Similarly, Balajee et al . reported a case of invasive pulmonary aspergillosis caused by P. alliaceus (teleomorph of Aspergillus alliaceus ) [10]. Case reportA 64-year-old male was admitted to the Emergency Department of Akdeniz University Medical Faculty with a 10-day history of abdominal pain, cough, shortness of breath and fever. On physical examination, he had a blood pressure was 120/70 mmHg, a pulse of 92 beats/minute, temperature of 38.5 ° C, and a respiration rate of 22 breaths/minute. There were rales at bilateral lower lobes at auscultation and the liver was palpable 2 cm from the mid clavicular region. The results of his blood tests were: hemoglobin, 88 g/l; platelet count, 41 ϫ 10 9 /l; white blood cell (WBC) count, 4 ϫ 10 9 /l; and C-reactive protein (CRP), 98 mg/l. Ninety percent of the leukocytes were blasts in the peripheral blood smear. He was hospitalized because of fever, neutropenia and de novo leukemia. Cefepime (3 ϫ 2 g/day) and clarithromycin (2 ϫ 0.5 g/ day) were started empirically after samples for blood cultures We report a case of a pulmonary infection caused by Aspergillus fl avus and Aspergillus alliaceus in an acute myeloid leukemia patient. These isolates were identifi ed using traditional and sequencing-based molecular methods.

The most common site of cerebrospinal fluid (CSF) leakage is through the floor of the anterior fossa, which communicates with the ethmoid or frontal sinuses or with the nasal fossa. The sphenoid sinus is rarely implicated as a source of spontaneous CSF fistula. Transclival meningocele is an extremely rare lesion. A 36-year-old woman with a 1-year history of intermittent CSF rhinorrhea was found to have a transclival meningocele. The diagnosis of transclival meningocele was made by magnetic resonance (MR), 3-dimension-computerized tomography (CT). At operation, by a transsphenoidal approach, the transclival meningocele was packed with fasia lata graft, fat tissue, and bio-glue. This is the third case of transsphenoidal transclival meningocele producing rhinorrhea in an adult. Transclival meningocele should be taken into consideration in patients with spontaneous CSF rhinorrhea.

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