Ahmet Mete

Effects of intravitreal bevacizumab (Avastin®) therapy on retrobulbar blood flow parameters in patients with neovascular age‐related macular degeneration

To investigate the effects of intravitreal bevacizumab on retrobulbar circulation in patients with neovascular age‐related macular degeneration (AMD).

Reliability of positron emission tomography-computed tomography in identification of mediastinal lymph node status in patients with non-small cell lung cancer

OBJECTIVE The involvement of mediastinal lymph nodes is a very important prognostic factor in patients with potentially resectable non-small cell lung cancer. Our aim in this study was to investigate the value of positron emission tomographic-computed tomographic scanning in staging lung cancer, especially for mediastinal lymph node evaluation, and to determine whether this could decrease the need for mediastinoscopy. METHODS Seventy-eight patients with non-small cell lung cancer who were potential candidates for surgical resection and admitted to the thoracic surgery unit of our hospital from March 2006 to June 2008 joined this prospective study. Positron emission tomographic-computed tomographic scanning was performed as part of the prospective studies used to diagnose or stage the tumors. All 78 patients underwent tissue sampling of mediastinal lymph nodes to compare these with imaging results. The diagnostic efficacy of the computed tomographic and positron emission tomographic-computed tomographic scans compared with histopathologic findings were calculated with sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS Final histology was available on 397 lymph node stations (N1, N2, and N3) sampled from 78 patients during mediastinoscopy or surgical intervention. Sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing thoracic computed tomographic scanning were 45.4%, 80.5%, 27.7%, and 90%, respectively. The accuracy of computed tomographic scanning was 75.6%. The sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing positron emission tomographic-computed tomographic scanning were 81.8%, 89.5%, 56.2%, and 96.7%, respectively. CONCLUSION There is a need for mediastinoscopy in positron emission tomographic-computed tomographic scanning-positive mediastinal lymph nodes, but it might not be necessary for positron emission tomographic-computed tomographic scanning-negative lymph nodes.

Dicephalic parapagus conjoined twins: A rare second trimester sonographic diagnosis

Conjoined twins are 1 of the rarest and most challenging congenital malformations. It occurs if twinning is initiated after the embryonic disc and rudimentary amniotic sac have been formed. We report a very rare case of dicephalic parapagus that was diagnosed by transabdominal sonography.

Eyelid Myoclonia With Absence Seizures in a Child With L-2 Hydroxyglutaric Aciduria: Findings of Magnetic Resonance Imaging

l-2 hydroxyglutaric aciduria is a rare, autosomal recessively inherited metabolic disorder of organic acid metabolism. A 5-year-old boy presented with eyelid myoclonia with absences that proved difficult to control with first-line anticonvulsants. An electroencephalogram produced profoundly abnormal results, with generalized spike-and-wave discharges. The patient became seizure-free with a combination therapy of clonazepam, levetiracetam, and lamotrigine. Magnetic resonance imaging demonstrated subcortical white matter and basal ganglia alterations. Urinary organic acid analysis demonstrated increased excretion of l-2 hydroxyglutaric acid. Although rare, seizures can occur as a presenting sign of slowly progressing organic acidurias, e.g., l-2 hydroxyglutaric aciduria. Both eyelid myoclonia with absences and l-2 hydroxyglutaric aciduria comprise rare disorders. To our knowledge, this case report is the first of l-2 hydroxyglutaric aciduria presenting with symptomatic eyelid myoclonia with absences.

Can the Hounsfield unit predict the success of medically expulsive therapy

BACKGROUND We investigate the predictability of medical expulsive therapy (MET) success with alpha blockers based on Hounsfield unit (HU) values and Hounsfield density (HD) values measured by computed tomography (CT) for distal ureteral stones. METHODS Between July 2011 and May 2012, 44 patients (19 female and 25 male) with 5- to 10-mm stones in the distal ureters were included in this randomized prospective study. Non-contrast CT examinations were performed in these patients. HU and HD values of stones were calculated. Doxazosine, 4 mg/day orally, was administered as a single dose to all patients for MET. RESULTS Patients were divided into 2 groups. Group 1 included 18 patients (43.9%) with dropped stones with MET. Group 2 included 23 patients (56.1%) with no stone passage with MET. In Group 1, the mean stone size was 7.7 mm, the mean HU was 507, and the HD was 53.04/mm. In Group 2, the mean stone size was 8.25 mm, the mean HU was 625, and the mean HD was 61.54/mm. The HU and HD values in Group 2 were higher than in Group 1. However, there was no statistically significant difference (p = 0.85 and 0.93 for HU and HD, respectively). INTERPRETATION We found that HU and HD values cannot be used to predict the chances of success for MET. Although the sample size is appropriate for the study, further comparative studies involving more patients are warranted.

An extraordinary cause of vertebral fracture in pregnant woman: brucellosis.

Herein, we report the unique case of Brucella-related lumbar vertebral fracture in a first trimester pregnant woman. The unique effective treatment protocol for the infection is prolonged combined antibiotics and immobilization with follow-up, even in the presence of vertebral fracture related to spinal disease. With the accurate choice of anthiobitics (suitable, non-teratogenic and non-toxic for the fetus) therapeutic abortion is not indicated.

Intraorbital haematoma during a commercial flight: a case report

BackgroundIntraorbital haematoma is a rare clinical entity which can be caused by orbital traumas, neoplasms, surgeries nearby sinuses and orbit, vascular malformations, acute sinusitis, systemic abnormalities, barotrauma and valsalva maneuver.Case PresentationA 74-year-old male presented with sudden onset of ocular pain, upper eye lid swelling, proptosis and diplopia after a commercial flight. After complete ophthalmic ocular examination including pupillary light reflexes and laboratory examinations; computed tomography and magnetic resonance imaging of orbit revealed a subperiostal mass-like lesion in the right retrobulbar-extraconal region which was compatible with intraorbital haematoma. Visual acuity was not compromised so we planned a conservative approach with close observation. We administered systemic corticosteroid and topical dorzolamide/timolol combination therapy. At the first month follow-up, intraorbital haematoma resolved without significant sequelae.ConclusionIntraorbital haematoma can be managed by conservative approach without any intervention if it does not threat visual acuity or optic nerve. We experienced a case of intraorbital haematoma during a commercial flight. We discussed the rarity of this condition and its management.

Does phacoemulsification under topical anesthesia affect retrobulbar blood flow

To investigate with color Doppler imaging the effects of phacoemulsification surgery under topical anesthesia on retrobulbar vessels hemodynamics.

Doppler ultrasonographic measurement of short‐term effects of valsalva maneuver on retrobulbar blood flow

To investigate the effects of Valsalva maneuver (VM) on retrobulbar blood flow parameters in healthy subjects.

Effectiveness of CT Computed Tomography Perfusion in Diagnostics of Acute Ischemic Stroke.

Summary Background Stroke is the third most common death reason after the cardiovascular disorders and cancer. Cerebral ischemia is a pathology that stems from a decrease in cerebral perfusion. Computed Tomography Perfusion (CTP) is an additional method to the conventional Computed Tomography (CT) that could be performed by using developed softwares, in a short period of time and with a low risk of complications. CTP not only allows early detection of cerebral ischemia but also gives valuable information on the ischemic penumbra which are very important in early diagnosis and treatment. Acute Ischemic Stroke (AIS) can be cured by trombolytic treapy within 3–6 hours after symptom onset. Since rapid screening and accurate diagnosis increase the success of the treatment, the role of neuroradiology in acute ischemia diagnostics and treatment has become more important. Our aim was to define CT skills in early diagnosis of AIS, to define its contribution to patient’s diagnosis and treatment and to define its importance regarding patient’s prognosis. Material/Methods We included 42 patients that presented to the emergency service and neurology outpatient clinic with the symptoms of acute cerebral incidence. Results In our study, we found that Cerebral Blood Flow (CBF) is 90.91% sensitive and 100% specific in examining ischemia. Conclusions Tissue hemodynamic data, especially sensitivity and specificity rates, which cannot be acquired by conventional CT and MRI methods, can be acquired by the CTP method.