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Background: Mandibular anesthesia is a frequently preferred anesthesia technique in the restorative, pulpal and surgical treatments of milk molars and permanent molars, as well as in mandible fractures and all surgical interventions that involve the mandible. In this reason, localization differences of mandibular foramen should be taken into consideration while applying mandibular anesthesia technique in patients. The aim of this study is to evaluate the localization of the mandibular foramen in living adults with three-dimensional computed tomography images. Materials and Methods: The study was carried out retrospectively on the radiologic images of 200 randomly selected adult individuals who had computed tomography examination for paranasal sinus and/or head and neck pathologies. The closest vertical (A) and horizontal (C) distances from mandibular foramen to margins of mandibular ramus and total vertical (B) and horizontal (D) distances of mandibular ramus were measured bilaterally in the edandate and dendate individuals, and the A/B and C/D ratios were evaluated. Results: When the measurements of dentate and edentate mandibles were compared, a statistically significant difference was found in all parameters (A, B, C, D, A/B, C/D) and it was determined that the measurements of dentate mandibles were larger than those of edentate mandibles. When the mandibular measurements were compared according to the sides (left/right), the A and D measurements and AB ratio in the right dentate mandibles and the B, C, D measurements and AB, CD ratios in the right edentate mandibles were statistically significantly larger than the left side. When the measurements were compared by gender, the B, C, D measurements and AB ratio of male dentate mandibles were statistically significantly higher than females. Conclusion: It was determined that mandible measurements of dentate cases were larger than edentate mandible. Mandibular ramus can be asymmetrical and ramus morphometers may be affected by gender within the clinical syndromes. This study demonstrates that the anatomical landmarks determined to find the target area for nerve block and to determine the safety zone for the ramus osteotomy lines can vary depending on the presence of the teeth. Amaç: Mandibular anestezi, süt ve kalıcı azı dişlerinin pulpa, restoratif ve cerrahi tedavilerinde, mandibula kırıklarında ve mandibulayı ilgilendiren tüm cerrahi girişimlerde sıklıkla tercih edilen bir anestezi tekniğidir. Bu nedenle hastalarda mandibular anestezi tekniği uygulanırken foramen mandibulae lokalizasyon farklılıkları dikkate alınmalıdır. Bu çalışmanın amacı, yaşayan erişkinlerde foramen mandibulaenin lokalizasyonunun üç boyutlu bilgisayarlı tomografi görüntüleri ile değerlendirmesidir. Gereç ve Yöntemler: Çalışma, paranazal sinüs ve/veya baş-boyun patolojileri için bilgisayarlı tomografi incelemesi yapılan rastgele seçilmiş 200 erişkin bireyin radyolojik görüntüleri üzerinde retrospektif olarak gerçekleştirildi. Foramen mandibulaedan ramus mandibulae kenarlarına en yakın dikey (A) ve yatay mesafeler (C) ve ramus mandibulaenın toplam dikey (B) ve yatay mesafeleri (D) dişli ve dişsiz bireylerde bilateral olarak ölçüldü. Bulgular: Dişli ve dişsiz mandibula ölçümleri karşılaştırıldığında, tüm parametrelerde (A, B, C, D, A/B, C/D) istatistiksel olarak anlamlı bir fark bulundu ve dişli mandibula ölçümlerinin dişsiz mandibulalara göre daha büyük olduğu belirlendi. Mandibular ölçümler laterilizasyona (sol/sağ) göre karşılaştırıldığında, sağ dişli mandibulada A ve D ölçümleri ve AB oranı ile sağ dişsiz mandibulada B, C, D ölçümleri ve AB, CD oranları istatistiksel olarak anlamlı derecede sol taraftan daha büyük bulundu. Ölçümler cinsiyete göre karşılaştırıldığında erkek dişli mandibulanın B, C, D ölçümleri ve AB oranı kadınlara göre istatistiksel olarak anlamlı derecede yüksekti.

WOS:000600134800008 PubMed: 33489555 Introduction and objective: This study aims at using sonoelastography as a novel technique to evaluate the stiffness and thickness of Achilles tendons in familial Mediterranean fever (FMF) patients. Methods: Achilles tendons of 26 FMF patients and 23 control subjects were assessed with ultrasound and real-Lime sonoelastography. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to their elasticity features: grade 1 blue (hardest tissue) to green (hard tissue); grade 2, yellow (soft tissue); and grade 3, red (softest tissue). Tendons of the groups were compared in terms of thickness and stiffness. Results: There were no significant differences in thickness and stiffness of the Achilles tendon between FMF patients and controls (p>0.05). Sonoelastography of Achilles tendons of FMF patients displayed no relationship between FMF and tendinopathy. Conclusion: This issue should be explored in prospective studies in larger groups.

Psödohipoparatiroidi, parathormona karşı hedef organ düzeyinde cevapsızlık nedeniyle hipokalsemi ve hiperfosfatemi gelişmesiyle karakterize bir bozukluktur. Oldukça az görülen bu durumun iki tipi vardır, Tip 1 üç alt gruba ayrılmıştır. Psödohipoparatiroidi Tip 1A, diğer adıyla Albright’ın herediter osteodistrofisi klinikte karakteristik yuvarlak yüz görünümü, frontal bombelik, kısa boy, obezite, brakidaktili ve mental retardasyonu olan hastalarda kolaylıkla tanınabilirken, Tip 1B ve Tip 1C’de normal fenotipik özellikler ve normal zeka vardır. Tip 1’de paratiroid direnci ile birlikte TSH ve gonadotropin direnci de tanımlanmış hastalar bulunmakta iken, Tip 2’de sadece paratiroid hormon direnci tanımlanmıştır. Ellerde, ayaklarda kasılma şikayeti ile Kalp-Damar Cerrahisi polikliniğine başvuran 12 yaşındaki kız hastaya oldukça nadir bir durum olan psödohipoparatiroidi Tip 2 tanısı koyarak; kalsiyum, D vitamini ile başarılı bir şekilde tedavi etmemiz nedeniyle olgu sunumu yaptık., Pseudohypoparathyroidism is a disorder characterized by hypocalcemia and hyperphosphatemia due to unresponsiveness of target organs to the parathormone. In this quite rare condition two types of disease exists and type 1 have 3 subtypes. Pseudohypoparathyroidism type 1A is known as Albright’s hereditary osteodystrophy, is clinically recognizable in patients with characteristic round face, frontal camber, short stature, obesity, brachydactyly and mental retardation, in type 1B and in type 1C, normal phenotypic features and normal intelligence were present. With parathyroid hormone resistance, TSH and gonadotropin resistance has also been identified simultaneously in type 1 patients, while in type 2 patients only parathyroid hormone resistance has been defined. Because of it was a very rare condition, we present a twelve years old girl patient admitted to Cardiovascular Surgery outpatient polyclinic with the complaint of spasm in hands and feet, diagnosed as pseudohypoparathyroidism type 2 who was treated successfully by calcium, vitamin D.

Mediastinal liposarkomlar, tüm mediastinal tümörlerin %1’inden azını oluşturur. Genellikle posterior mediasten yerleşimlidirler. Miksoid liposarkomlar, sıklıkla genç yaş grubunda görülür ve 5. Dekatta pik yaparlar. Ses kısıklığı şikâyetiyle başvuran 39 yaşındaki hastada, orta-posterior mediasten yerleşimli 9 cm çapında kitle tespit edildi. Olgu biyopsi ile liposarkom tanısı aldı. Kitle cerrahi olarak çıkarıldı. Erken dönemde nüks görüldü ve kemoterapi uygulandı. Temel tedavi yöntemi cerrahi eksizyon olan bu tümörlerde, çok sık nüks görülmesi sebebiyle, takip oldukça önemlidir. Gerekli vakalarda kemoterapi ve radyoterapi tedaviye eklenmelidir., Mediastinal liposarcomas comprise less than 1% of all of the mediastinal tumors. They are generally located in the posterior mediastinum and seen in young age population. Tumors make peak in the fifth decade. A mass of nine cm diameter is found in middle-posterior mediastinum of 39 years old patient with hoarseness. The mass is diagnosed as liposarcoma in biopsy and excised surgically. The tumor is recurred in early period and chemotherapy is administered. The follow up in these tumors, for which the surgical excision is the first treatment choice, is very important because of the early recurrences. Chemotherapy and radiotherapy must be added to treatment in required cases.

Objective Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. In the present study, we aimed to investigate the potential factors including age, intervertebral disc degeneration (IDD), facet joint degeneration (FJD), end plate degeneration (EPD), which may affect LF thickening and to reveal the relationship among those factors at each level of lumbar spine by evaluating the magnetic resonance images (MRI). Methods A total of 200 individuals with low back and/or leg pain complaints who had undergone lumbar MRI were included in this study. The thickness of LF, FJD, IDD and EPD were assessed at all lumbar levels. Results Totally 1000 end plates, 1000 intervertebral discs and 2000 facet joints were evaluated and the thicknesses of 2000 LFs were measured from MRI images of 200 patients (100 males and 100 females). The mean age was 46.87 ± 12.47 years. LF thickness was strongly associated with FJD especially on the ipsilateral side. Age and IDD were correlated at whole vertebral levels. The age related changes (LF thickness, FJD, IDD and EPD) were more prominent at L4-L5 vertebral level. However, gender had no effect on LF thickness. Conclusion The results of this study suggest that LF thickening may occur independently or could be associated with FJD especially on the ipsilateral side and this relationship is due to the vertebral level. The degree of disc degeneration increases with age and age related changes may be predominantly observed at L4-L5 vertebral level.

Summary The aim of this study was to investigate whether enoxaparin (ENX) administration would increase seroma risk and worsen mesh tissue recovery in an experimental rat hernia repair model. Fifty-six adult male Wistar–Albino rats were included in the study. Rats were equally and randomly separated into seven groups: Group 1, Control, only subcutaneous dissection was performed; group 2, Sham, Hernia defect was primary sutured; Group 3, Prolene mesh; Group 4, Dual mesh; Group 5, ENX + Sham; Group 6, ENX + Prolene mesh; Group 7, ENX + Dual mesh. ENX was subcutaneously injected at a dose of 180 U/kg per day for 7 days. Rats were killed after the amount of subcutaneous seroma was determined by ultrasound on day 7 following the surgical procedure. Mesh-tissue healing was evaluated using histopathological and immunohistochemical (CD31) staining methods. The mean seroma amount significantly increased in Groups 5–7 compared to Groups 2–4. CD31 immunostaining showed a reduction in neovascularization in Groups 6 and 7, compared to Groups 3 and 4. Neovascularization decreased and hemorrhage, necrosis and oedema findings remarkably increased in Groups 6 and 7, when compared to Groups 3 and 4. Fibroblastic activity and inflammation were more prominent in Groups 3 and 4. It should be kept in mind that ENX interferes with inflammation, which is desired in the early period of healing and leads to an increase in overall seroma amount with anti-coagulant effects, which in turn may disrupt wound healing and mesh-tissue adhesions, as was indicated in our study.

The purposeof our study is to evaluate the location of the mandibular foramen according toage, gender and location (right / left) using three dimensional computerizedtomography in living persons in the pediatric population. This study included102 pediatric patients who underwent cranial computerized tomograghy for anyreason. Averages and standard deviations of the parameters examined weredetermined. Gender (female / male) and regional (right / left) comparisons ofthe obtained data were statistically evaluated and the age-related collateralsof the parameters were evaluated. In our study, distance between mandibularforamen and mandibular notch was 13,4±2,2 mm; distance between the lower edgeof the mandible and mandibular notch was 34.8 ± 4.4 mm, distance betweenmandibular foramen and backside of mandibular ramus was 9.1 ± 1.8 mm, mandibularanteroposterior diameter was 24 ± 2.4 mm. There was no significant differencebetween male-female and right-left comparisons. There was positive correlationbetween age and measurements. When we compare the information obtained in ourstudy with the knowledge of the literature, it is observed that many of thebulges are similar but there are differences in some measurements. Thesedifferences suggest that other studies performed on dry bones and panoramicradiographs, working in different age groups, racial differences, differentmethods of measurement, and less work on computerized tomograghy studies. Mandibularforamen have certain age-related changes, and longitudinal anatomical studiesare needed to confirm these differences. The exact location of the foramenmandibulae in the pediatric population is of great importance in terms ofreducing the anesthetic complications in mandibular anesthesia., Çalışmamızın amacıpediatrik populasyonda canlı kişilerde üç boyutlu bilgisayarlı tomografikullanarak foraman mandibulae’nın lokalizasyonunu yaş, cinsiyet ve yerleşimine(sağ/sol) göre değerlendirmektir. Bu çalışmaya herhangi bir nedenle kraniyalbilgisayarlı tomografisi çekilmiş 102 pediatrik hasta dahil edildi. İncelenenparametrelerin ortalamaları ve standart sapmaları belirlendi. Elde edilenverilerin cinsiyet (kız/erkek) ve bölge (sağ/sol) karşılaştırması istatistikselolarak değerlendirildi ve parametrelerin yaşa bağlı korelasyonuna bakıldı.Çalışmamızda foramen mandibulae ile incisura mandibula arasındaki uzaklıkortalama 13,4±2,2 mm olarak, mandibulanın alt kenarı ile incisura mandibulaarasındaki uzaklık 34,8±4,4 mm, foramen mandibulae ile ramus’un arka kenarınaolan transvers mesafe 9,1±1,8 mm, mandibulanın anteroposterior çapı 24±2,4 mmbulundu. Kız – erkek ve sağ-sol karşılaştırmasında anlamlı bir fark yoktu. Yaşile ölçümler arasında pozitif yönde korelasyon bulundu. Çalışmamızda eldeedilen bilgileri literatür bilgisi ile karşılaştırdığımızda birçok bulgununbirbirine benzer olduğu ancak bazı ölçümlerde farklılıklar olduğu gözlemlenmektedir.Bu farklılıklar, diğer çalışmaların kuru kemiklerde ve panoramikradyografilerde yapılmış olması, farklı yaş gruplarında çalışılmış olunması,ölçüm yöntemlerinin farklı olmasından ve canlı üzerinde bilgisayarlı tomografiile yapılan çalışmaların az olmasından kaynaklanmaktadır. Foramen mandibulae’dayaşla ilgili belirli değişiklikler vardır ve bu farklılıkları doğrulamak içindaha çok anatomik çalışmalara ihtiyaç vardır. Pediatrik populasyonda foramen mandibulaelokalizasyonun tam olarak bilinmesi yapılacak olan mandibular anestezilerdeanestezik komplikasyonların azaltılması açısından büyük önem arz etmektedir.

Introduction Serious problems on muscle strength and functional status can be seen in bedridden-patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation. Methods Thirty conscious COPD patients (F/M:15/15) hospitalized in the intensive care unit (ICU) with diagnosis of respiratory failure were enrolled to this study. Patients were randomized into three groups, including 10 patients for each. Active extremity-exercise training and NMES were applied to Group-1, only NMES was applied to Group-2 and active extremity exercise training was applied to Group-3. Muscle strengths, mobilization duration and weaning situation were evaluated. Serum cytokine levels were evaluated. Results Lower extremity muscle-strength was significantly improved in Group-1 (from 3.00 to 5.00, P = 0.014) and 2 (from 4.00 to 5.00, P = 0.046). Upper extremity muscle strength was also significantly improved in all three groups (from 4.00 to 5.00 for all groups, P = 0.038, P = 0.046 and P = 0.034, respectively). Duration of mobilization and discharge from the ICU were similar among groups. There was a significant decrease in serum interleukin (IL)-6 level in Group-1 and in serum IL-8 level in Group-1 and Group-2 after rehabilitation. Conclusion This study indicates that pulmonary rehabilitation can prevent loss of muscle strength in ICU. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden ICU patients who are mechanically ventilated.

WOS: 000363278900021, PubMed ID: 25921625, Central venous port catheters and peripherally inserted central catheters (PICC lines) are implanted in the central venous system usually for administration of chemotherapeutic agents and parenteral nutrition [1,2]. Long-term use of these catheters may cause such complications as occlusion, thrombosis, infection, fracture and intravascular dislocation of the catheter [2,3]. The incidence of intravascular dislocation of port catheters is rare( 0-3.1%) [1,3]. Fragments of a fractured port catheter might migrate towards the heart or pulmonary artery and cause embolization in the distal region of the organ resulting in mortality [1,4]. Therefore, port catheter fragments must be retrieved as soon as possible[ 1]. Percutaneous retrieval, removal by open thoracotomy and long-term anticoagulant therapy are the treatment options for fractured port catheters. Among these options, percutaneous transcatheter retrieval is usually a safe and effective method [1,5]. In this study, we report the retrieval of port catheter fragments extending from the superior vena cava to the right cardiac cavities using a three-loop 6F 12-20 mm snare( Atrieve Vascular Snare (TM); Angiotech, Gainesville, FL, United States) in two patients who complained of chest pain.

WOS: 000369319000011, PubMed: 26511018, Objective The aim of this study was to evaluate the carotid intima media thickness (IMT) in patients with thyrotoxicosis who received radioactive iodine (RAI) treatment. Methods This study was planned to be conducted with two different groups of people. There were 87 patients in the patient group and 98 controls. Participants were evaluated for atherosclerosis risk factors. Mean carotid IMT was measured from three consecutive traces at the common carotid artery bifurcation. Results The mean carotid IMT was 0.81 +/- 0.20 in patient group and this was higher than the controls (0.68 +/- 0.19) (p < 0.01). IM thickening was positively correlated with the applied RAI dose levels in the treatment group (p = 0.029). In patients with only HT, the data of the two groups showed a significant difference, with the average IMT being higher in the patient group than that of the control group (p: 0.011). Conclusion RAI used in the treatment of thyrotoxicosis increases the IMT of carotid artery independent of age and sex. This treatment yields better results with higher doses, and this effect is more marked in patients with HT. Hence, we believe that it is necessary to calculate the dose properly for hyperthyroid cases in which treatment with RAI is planned. In particular, the patients with HT need to be treated with the minimum possible dose. Further, carotid arteries should be evaluated with US following RAI treatment.

Neck bypass failure in endovascular treatment of wide-necked internal carotid artery (ICA) aneurysms may adversely affect the technical success of the procedure. We used the gently pull-back technique to bypass the aneurysm neck and access the distal parent artery during endovascular treatment in patients with wide-necked ICA aneurysms. In this technique, a loop was made in the aneurysm and the distal parent artery was reached by using a small diameter microguidewire and a microcatheter. After providing reliable distal access, the microguidewire was removed and the whole system which consists of the microcatheter was gently pulled back. Finally the microcatheter was straightened and the aneurysm neck was passed. After crossing the aneurysm neck, a flow-diverting stent treatment and stent-assisted coiling were performed in three cases with wide-necked ICA aneurysm. The gently pull-back technique is a simple and effective method which requires no extra intravascular device and helps to bypass the aneurysm neck through a small diameter microguidewire and a microcatheter. This technique may be useful for neck aneurysm bypass in endovascular treatment of wide-necked ICA aneurysms.

Endovascular treatment of wide-necked bifurcation aneurysms can be challenging, despite improvements in endovascular techniques. Y stent-assisted coiling is one such technique, but this may not be technically feasible, especially in cases of acute angulation between the proximal and distal parent arteries, and may require use of -modified Y-configured stents with the waffle-cone technique-. We report three cases of wide-necked bifurcation aneurysms that were successfully treated by use of the Solitaire (R) stent.

Objective: Despite the development of effective systemic treatments and new biological agents for psoriasis nowadays, topical medications are still the mainstay of treatment. Topical calcineurin inhibitors are currently used in various skin diseases. We investigated The efficacy and safety of tacrolimus, which is an alternative in topical treatment, is investigated in comparison with the present medications in plaque psoriasis. Material and Methods: This prospective double-blind plasebo-controlled study was conducted in 24 patients with diagnosis of plaque psoriasis who were seen in X University Hospital dermatology outpatient clinic. 0.1% tacrolimus ointment, 0.1% mometasone furoate ointment, 0,005% calcipotriol ointment and plasebo in encrypted bottles, were randomly applied in test chambers under occlusion, in every other day, during 19 days, to 27 psoriatic plaques. Clinic sum scores, side effects, epidermal thickness measured by superficial ultrasound were noted before and after treatment in all microplaques. Besides histopathologic scoring and epidermal thickness were measured in 9 patients at the end of study. Results: The clinic sum scores and ultrasonographic epidermal thickness at the end were both significantly lower than the beginning values in all microplaques (p˂0.05). The reduction in these two values with tacrolimus were significantly higher than plasebo (p˂0.001), but no difference with calcipotriol (p=0.287, p=0.813, respectively). On the other hand, the reduction in these values with mometasone were significantly higher than tacrolimus (p˂0.05). Mometasone furoate was the most effective when the difference of total histopathological score and epidermal thickness of the three ointments from plasebo at the end were compared. Conclusion: Tacrolimus ointment is an alternative topical medication in plaque psoriasis under occlusion. Occlusion in practice requires patients compliance. Thus studies to find a a new formulation that will increase absorption of drug from thick psoriatic plaques are necessary.

Objective: We aimed to evaluate the efficacy of the percutaneous nephrostomy (PN) performed by using combined ultrasonography (USG) and fluoroscopy. Methods: Eighty-seven patients (48 female, 39 male; mean age, 58.2; range, 19-91) who underwent 106 PN procedures performed by using USG and fluoroscopy combination between July 2011 and May 2015 were retrospectively analyzed. The technical success was considered if nephrostomy catheter was placed within renal pelvis and functioned spontaneously. All patients received preprocedural prophylactic antibiotic and preprocedural coagulation parameters and platelet count were tested in all patients routinely. The procedural complications are classified as major, minor and catheter-related. The technical success rates and complication rates of the PN procedure were calculated. Results: PN was performed for benign causes in 47 patients (54%) and for malignant causes in 40 patients (46%). A total of 106 nephrostomies were performed in 101 kidneys (95.1%) with dilated systems and in 5 kidneys (4.9%) with non-dilated systems. The technical success rate of PN was 98.1% (104/106 PN procedures). Major complication was not observed in any patients. Transient hematuria as a minor complication was seen in 11 patients (12.6%). Catheter dislodgement occurred in 11 patients (12.6%). Conclusion: The PN performed by using combined USG and fluoroscopy is effective and reliable procedure in urinary decompression and diversion with high success and low complication rates. J Clin Exp Invest 2015; 6 (2): 170-174

The purpose of this prospectively designed cross-sectional observational study was to evaluate the effect of polycystic ovary syndrome (PCOS) on pituitary gland volume (PGV) under the hypothesis that endocrinologic changes may lead to morphologic changes of the pituitary gland. Twenty-six PCOS patients and 31 control subjects underwent magnetic resonance imaging (MRI) of the pituitary. Informed consent was obtained from all subjects. PGV was significantly larger in PCOS patients than in control subjects. Luteinizing hormone/follicle-stimulating hormone ratio was the only predictor of PGV. The association between pituitary gland enlargement and PCOS should be kept in mind when pituitary hypertrophy is detected on MRI.

WOS: 000389599300020 PubMed: 27050637 …

Poster: "ECR 2015 / C-1270 / Assessment of neural alterations in obstructive sleep apnoea syndrome: can apparent diffusion coefficient measurements be useful?" by: "E. Kacar, S. Sarinc Ulasli, E. Gunay, G. Gungor, E. Unlu, M. Beker Acay, T. Koyuncu, M. Unlu, A. Haktanir; Afyonkarahisar/TR"

Hydatid cyst (HC) disease is a zoonotic disease caused by the larvae of Echinococcus granulosus. We report our experience of treating HC manifesting aggressive characteristics. Between January, 2010 and December, 2013, 40 patients underwent surgery for HC disease in our department. The subjects of this study were six patients whose disease followed an aggressive and invasive clinical course. The HC disease in these patients involved the vertebrae, chest wall, mediastinum, diaphragm, and lung, with destruction of the lung. There were four men and two women, with a mean age of 47 years (range 12–81 years). Treatment consisted of cystectomy and additional procedures, such as corpectomy and resection of the chest wall, approaching the liver and spleen with phrenotomy and lobectomy. One patient suffered prolonged biliary drainage, and another had a bronchopleural fistula and atelectasis. One patient died of empyema 1 month postoperatively. The mean hospital stay was 9 days. In some patients, HCs can act as an aggressive tumor, involving the surrounding tissues, organs, and even bony structures. Aggressive HCs may cause various sequelae and require extended surgical interventions in addition to cystectomy.

Unilateral absence of a pulmonary artery a very rare congenital disorder. We here present a case of a 22-year-old female patient with agenesis of the right pulmonary artery accompanying patent ductus arteriosus and Eisenmenger syndrome, diagnosed by chest X-ray and multidetector computed tomography 5 days after giving birth.

Neural fibrolipoma is characterized by infiltration of the epineurium by adipose and fibrous tissue. Intradural spinal cases are extremely rare. We report an unusual case of spinal neural fibrolipoma. A 31-year-old pregnant woman presented due to weakness of right leg (muscle strength 2/5). Magnetic resonance (MR) evaluation of the spine revealed an extramedullary intradural mass at the T1-T4 level. MR findings were suggesting a dermoid cyst or a lipoma. Subtotal surgical excision of the tumor was done. Histopathological examination showed enlarged nerve bundles infiltrated by fibroadipose tissue. Thus, the diagnosis of neural fibrolipoma was established. One month after surgery, lumbar MR showed residual tumor tissue, but successful decompression of the spinal cord. Six months after surgery, the neurological examination, muscle strength 4/5 evaluated. Neural fibrolipoma is characterized by infiltration of the epineurium by adipose and fibrous tissue. The tissue grows between and around nerve bundles thereby causing enlargement of the affected nerve. Neural fibrolipoma is a benign lesion with no effective therapy. Surgical excision usually causes severe damage of the involved nerve. Although spinal cases are extremely rare, it should be included in the differential diagnosis of extramedullary intradural masses.

Background Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. Material and methods Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. Results There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. Conclusions Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy.

Introduction Computed tomography pulmonary arterial obstruction index ratio (CTPAOIR) is related with the severity of pulmonary embolism (PE). Platelet indices including mean platelet volume (MPV), platelet distribution width (PDW) are reported to be increased in acute PE. Objective In this study, we aimed to evaluate the relationship between CTPAOIR and platelet indices and the utility of these parameters in the determination of PE severity. Materials and Methods We retrospectively analysed the demographic data, clinical probability scores, laboratory data and echocardiographic findings of 63 acute PE patients who were diagnosed by pulmonary arterial computed tomography angiography. Results The hospital records of 38 (60.3%) male and 25 (39.7%) female patients with acute PE and 29 (58%) male and 21 (42%) female healthy control were evaluated (P = 0.803). The mean value of MPV, PDW levels, platelet counts and red cell distribution width levels were higher in PE groups than in control subjects (P

The primary objective of this study was to assess the effect of age and sex on the severity and localization of osteophyte formation from three-dimensional (3D) volume rendered (VR) multidetector computed tomography (MDCT) images of thoracolumbar vertebrae. 3D VR MDCT images of thoracolumbar vertebrae of 564 adult living individuals (285 female and 279 male) with ages ranging from 20 to 84 years were studied. The study population was divided into seven groups according to age, and the severity of osteophytosis scored using a scale from 0 to 4 for each vertebra. Osteophyte scores were significantly correlated with age between 40 and 70 years of age in both males and females. Of the four vertebral regions (upper, middle, and lower thoracic, lumbar) the severity was highest in the middle thoracic region between 20 and 70 years of age and in the lower thoracic region between 70 and 90 years. Lower thoracic vertebrae presented a significant sex difference. The localisation and severity of osteophytosis varies with age and shows sexual dimorphism. Our findings will be useful for forensic work in age and sex determination. © 2016 Australian Academy of Forensic Sciences.

Objective: The purpose of this study was to investigate the effect of recanalization on stenotic internal carotid arteryon brain volume changes in stent applied patients.Materials and Methods: Carotid stenting was performed in 17 patients with severe carotid artery stenosis betweenJune 2013 and April 2014. High resolution 3D T1 weight images were obtained from each patient 24 hours beforeand 7.2 ± 3.6 months (mean ± standard deviation) after the procedure on a 3T magnetic resonance imaging scanner.Intracranial total cortical grey matter, total cortical white matter, white matter hypointensity, total intraventricular andsubcortical grey matter volumes were assessed by FreeSurfer version 4.5.0.Results: A significant reduction was found in total cortical white matter and subcortical grey matter volumes (p

WOS: 000366656100001 PubMed: 26253990 …

Herniated nucleus pulposus is the most commonly encountered condition in lumbar region. Herniated disk frequently occurs in the anterior epidural region. However, posterior migration of disk body is very rare because of the anatomic structure. When a mass is detected in the posterior epidural region, various etiological factors such as tumors, abscess, and cysts are generally taken into consideration in differential diagnosis other than disk herniation; however, posterior migration of the disk herniation has also similar appearance to these mentioned conditions. In this case report, we aimed to discuss differential diagnosis of 2 patients with sequestrated disk herniation in whom posterior epidural mass was observed in magnetic resonance imaging and to review the literature. © 2014 Wolters Kluwer Health, Inc.

Purpose We aimed to evaluate the safety and effectiveness of single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm. Methods Hospital database was screened for patients who underwent single-stage endovascular treatment between February 2008 and June 2013 and seven patients were identified. The procedures included unilateral carotid artery stenting (CAS) (n=4), bilateral CAS (n=2), and proximal left subclavian artery stenting (n=1) along with ipsilateral intracranial aneurysm treatment (n=7). The mean internal carotid artery stenosis was 81.6% (range, 70%-95%), and the subclavian artery stenosis was 90%. All aneurysms were unruptured. The mean aneurysm diameter was 7.7 mm (range, 5-13 mm). The aneurysms were ipsilateral to the internal carotid artery stenosis (internal carotid artery aneurysm) in five patients, and in the anterior communicating artery in one patient. The patient with subclavian artery stenosis had a fenestration aneurysm in the proximal basilar artery. Stenting of the extracranial large vessel stenosis was performed before aneurysm treatment in all patients. In two patients who underwent bilateral CAS, the contralateral carotid artery stenosis, which had no aneurysm distally, was treated initially. Results There were no procedure-related complications or technical failure. The mean clinical follow-up period was 18 months (range, 9-34 months). One patient who underwent unilateral CAS experienced contralateral transient ischemic attack during the clinical follow-up. There was no restenosis on six-month follow-up angiograms, and all aneurysms were adequately occluded. Conclusion A single-stage procedure appears to be feasible for treatment of patients with severe extracranial large vessel stenosis and concomitant ipsilateral intracranial aneurysm.

The present study aims to determine the efficacy and reliability of cardiovascular magnetic resonance imaging in establishing the diagnosis and prognosis of pulmonary hypertension in children. This is a retrospective comparison of 25 children with pulmonary hypertension and a control group comprising 19 healthy children. The diagnosis of pulmonary hypertension was made when the mean pulmonary artery pressure was ≥25 mmHg by catheter angi- ography. The children with pulmonary hypertension had significantly lower body mass indices than did the healthy children ( P=0.048). In addition, the children with pulmonary hyper- tension had significantly larger main pulmonary artery diameters and ascending aortic diameters (both P=0.001) but statistically similar ratios of main pulmonary artery diameter- to-ascending aortic diameter. If the main pulmonary artery diameter was ≥25 mm, pedi- atric pulmonary hypertension was diagnosed with 72% sensitivity and 84% specificity. In the event that the ratio of main pulmonary artery diameter-to-ascending aorta diameter was ≥1, pediatric pulmonary hypertension was diagnosed with 60% sensitivity and 53% specificity. When compared with children who had New York Heart Association functional class II pulmonary hypertension, the children with functional class III pulmonary hyperten- sion had significantly larger main ( P=0.046), right ( P=0.036), and left ( P=0.003) pulmo- nary arteries. Cardiovascular magnetic resonance imaging is useful in the diagnosis of children with pulmonary hypertension. Pediatric pulmonary hypertension can be diagnosed with high sensitivity and specificity when the main pulmonary artery diameter measures ≥25 mm. (Tex Heart Inst J 2015;42(3):209-15) radiography; cardiac cath- eterization; child; hyperten- sion, pulmonary/diagnosis/ physiopathology; magnetic resonance imaging; pul- monary artery/radiography; retrospective studies; ROC curve; sensitivity and speci- ficity

Endovascular treatment of wide-necked bifurcation aneurysms may be challenging. The waffle-cone technique can be used in these aneurysms in case of acute angulation between parent artery and distal artery of the aneurysm. Solitaire® stent (Ev3, Irvine, CA, USA) has the significant advantage of mitigating the potential complication risks. This study reports the second case in the literature in which endovascular treatment of a wide-necked bifurcation aneurysm with the double waffle-cone technique by using twin Solitaire® stents proved to be successful.

We aimed to examine the prevalence of cerebellar tonsil ectopia and Chiari 1 malformation in sensorineural hearing loss (SHL) that has, to the best of our knowledge, not been studied previously. Magnetic resonance imaging records of 166 subjects with SHL and 50 controls without known otologic disturbances were included in the study. A tonsils descent more than 2 mm was assumed as cerebellar ectopia, and a descent equal to or more than 5 mm was assumed as Chiari 1 malformation. A tonsil descent group was also formed by summation of both groups. Transverse diameters of bilateral intracranial vertebral arteries and transverse sinuses were also measured, and all parameters were analyzed using appropriate statistics. A significant difference of frequencies of Chiari 1, ectopia, and tonsil descent was detected between patients and controls. In comparison of cerebellar ectopia and Chiari 1 groups, SHL did not show any significant difference. The left lateral sinus diameter showed positive correlation with tonsil descent. There was no significant correlation for the diameters of other vessels. A powerful correlation was detected between SHL and age. In addition, right and vertebral artery diameters showed positive correlations with age. Chiari 1 malformation and cerebellar ectopia showed an association with SHL. These patients should also be evaluated for otologic disturbances. Further high-resolution magnetic resonance imaging studies to explain the exact cause of this currently unknown association seems required.

The aim of this study was to analyze variations in the morphological features of the subparietal sulcus (SPS) and to investigate interhemispheric and gender differences in these variations using multiplanar reconstructed (MPR) magnetic resonance (MR) images. Two hundred subjects with normal cranial MR imaging, including high-resolution T1-weighted volumetric data, were enrolled in the study. The sagittal or oblique sagittal MPR images created from high-resolution T1-weighted data were analyzed for the following morphological features: the SPS patterns, the continuity of the SPS with the cingulate sulcus and parieto-occipital sulcus (POS), and the presence of upwardly directed SPS branches reaching to the hemispheric surface. Interindividual variability of the morphologic features, hemispheric asymmetry, and gender differences were investigated. Considerable variations were found in the morphological features of the SPS. The H-pattern, no connection with the cingulate sulcus or the POS, and one upwardly directed branch reaching the hemispheric surface were most commonly observed morphologic features of the SPS in 45.2, 41.8, and 48 % of the all hemispheres, respectively. Furthermore, the connection of the SPS only with the cingulate sulcus and the presence of two upwardly directed branches reaching the hemispheric surface showed the significant leftward asymmetry (P

Purpose Misty mesentery appearance is commonly reported in daily practice, usually as a secondary finding of various pathological entities, but sometimes it is encountered as an isolated finding that cannot be attributed to any other disease entity. We aimed to assess the prevalence of cases with incidentally detected idiopathic misty mesentery on computed tomography (CT) and to summarize the pathologies leading to this appearance. Methods Medical records and initial and follow-up CT features of patients with misty mesentery appearance between January 2011 and January 2013 were analysed. The study included cases with no known cause of misty mesentery according to associated CT findings, clinical history, or biochemical manifestations, and excluded patients with diseases known to cause misty mesentery, lymph nodes greater than a short-axis diameter of 5 mm, discrete mesenteric masses, or bowel wall thickening. Results There were a total of 561 patients in whom misty mesentery appearance was depicted on abdominopelvic CT scans. A total of 80 cases were found to have isolated incidental idiopathic misty mesentery, giving a prevalence of 7%. The common indication for CT examination was abdominal pain. There was a slight female predominance (51.3%). 67.5% of all patients were classified as obese and 17.5% as overweight. Conclusions The results of the present study show that idiopathic incidental misty mesentery appearance has a significant prevalence. Also, the high body mass index of these patients and the growing evidence of obesity-induced inflammatory changes in adipose tissue are suggestive of an association between obesity and misty mesentery appearance on CT.

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

Bu çalışmamızda; fethi kabir yapılarak elde edilen kemiklerden Radyolojik inceleme yoluyla cesedin iddia edilen kişiye ait olmadığı tespit edilen bir negatif kimliklendirme vakası sunulmaktadır. 2009 yılında ölen bir kadın kasaba mezarlığına defnedilmiş, bunun ertesi günü aynı kasabadan diğer bir kadın hayatını kaybederek aynı mezarlığın başka bir bölgesine defnedilmiştir. Davacıların iddiasına göre; ölen ablasının mezar yerini unutması nedeniyle davalı tarafından annelerine ait mezarın başındaki taş sökülerek hemen yanındaki boş bir mezara dikilmiş, inceleme konusu mezara da davalının ablasının ismi bulunan mermer bir mezar yaptırılmıştır. Davacılar, annelerinin 2006 yılının sonlarında sağ kalçasındaki kırık nedeniyle ameliyat olduğunu ve protez takıldığını belirterek buna ait tıbbi belgeleri mahkemeye delil olarak sunmuşlardır. Fethi kabir yapılarak çıkarılan ceset üzerindeki makroskopik incelemede proteze rastlanmaması üzerine kemiklerin radyografileri de çekilmiştir. Mezardan çıkarılan kemiklerde herhangi bir protez, ortez vida ya da metal cisim olmadığı, her iki femur başının yerinde olduğu saptanmıştır. Dolayısı ile davacıların iddiasının aksine inceleme konusu mezardaki cesedin annelerine ait olmadığı tespit edildiğinden DNA incelemesine gerek görülmemiştir. Sonuç olarak olgumuz, antemortem ve postmortem radyografilerin karşılaştırılmasının kimliklendirmede ne kadar büyük bir değere sahip olabileceğini ortaya koymaktadır. Bu durum, sağlık kuruluşlarında radyolojik görüntü kayıtlarının olabildiğince uzun süreyle ve güvenli bir biçimde saklanması gerektiğini de göstermektedir.Anahtar Kelimeler: Kimliklendirme; Adli Radyoloji; Kemik Protezi; Fethi Kabir

Patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. Atherosclerosis is associated with increased arterial stiffness (AS), endothelial dysfunction and elevated oxidative stress (OS) and inflammation. We aimed to investigate the relationship between oxidative stress status, arterial stiffness, hepcidin and fibroblast growth factor-21 (FGF-21) levels in CAPD patients. As a prospective observational study, we analyzed 56 CAPD patients, aged between 30 and 63 years. Serum hepcidin, FGF-21 levels, OS status and AS were determined. Arterial stiffness was measured by flow-mediated dilatation (FMD). Oxidative stress status was determined by total antioxidant status, total oxidant status (TOS) and oxidative stress index (OSI). FMD was negatively correlated with TOS, OSI, hepcidin and FGF-21 (r: −0.313, p: 0.020; r: −0.0331, p: 0.014; r: −0.498, p

Grisel’s syndrome is a nontraumatic atlantoaxial subluxation which is usually secondary of an infection or an inflammation at the head and neck region. It can be observed after surgery of head and neck region. Etiopathogenesis has not been clearly described yet, but increased looseness of paraspinal ligament is thought to be responsible. Patients typically present with painful torticollis. Diagnosis of Grisel’s syndrome is largely based on suspicion of the patient who has recently underwent surgery or history of infection in head and neck region. Physical examination and imaging techniques assist in diagnosis. Therefore, clinicians should be aware of acute nontraumatic torticollis after recently applied the head and neck surgery or undergone upper respiratory tract infection. In this paper, a case of an eight-year-old male patient who had Grisel’s syndrome after adenotonsillectomy is discussed with review of the literature.

The purpose of this study was to determine the accuracy of detecting knee effusion with clinical examination and to evaluate whether the amount of effusion, patient obesity, and the clinicians' experience affect the clinicians' decisions in patients with knee osteoarthritis. Patients presenting with knee pain were examined by two residents with different levels of experience and underwent ultrasonographic examination, including measurement of effusion in the medial, mid, and lateral aspects of the suprapatellar bursa. One hundred seventy-two knees of 86 patients were examined. Of the knees investigated, 127 (73.8 %) had effusion. The consistency between ultrasonographic and resident examination were weak (κ = 0.193, p = 0.007 and κ = 0.349, p

Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Dicle University, Diyarbakir, Turkey Department of Radiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey Department of Physical Medicine and Rehabilitation, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey Department of Neurosurgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey