Birsen Unal

Risky anatomic variations of sphenoid sinus for surgery

We searched for the surgically risky anatomic variations of sphenoid sinus and aimed to compare axial and coronal tomography in detection of these variations. Fifty-six paranasal tomography images (112 sides) were evaluated for coronal, axial and both coronal and axial images. Tomographic findings including bony septum extending to optic canal or internal carotid artery; protrusions and dehiscences of the walls of internal carotid artery, optic nerve, maxillary nerve and vidian nerve; extreme medial course of internal carotid artery; patterns of aeration of the anterior clinoid process; and Onodi cells were evaluated. The results were classified as “present, absent, suspicious-thin (only for dehiscence) or no-consensus”. The results of each plane were compared with that of the result of the both planes together. Kappa coefficient and Chi-square tests were used to compare both planes. Twelve cadaveric dissections were performed to reveal the proximity of sphenoid sinus to surgically risky anatomic structures. Endoscopy was applied to five cadavers. 18 evaluations were classified as ‘no-consensus’. We detected 34, 35, 34 and 40 protrusions of internal carotid artery, optic nerve, maxillary nerve, vidian nerve, respectively. Dehiscences were present in 6, 9, 4 and 8, and suspicious-thin in 8, 10, 16 and 25 in canals of internal carotid artery, optic nerve, maxillary nerve and vidian nerve, respectively. Bony septum to internal carotid artery and optic nerve was observed in 30 and 22 cases. We observed 9 extreme medial courses of internal carotid artery, 27 aerated clinoid process and 9 Onodi cells. Axial images were superior in detection of bony septum to internal carotid artery and Onodi cells; while the coronal images were more successful in detection of protrusion of optic nerve and vidian nerve, and dehiscense of maxillary nerve and vidian nerve (P<0.05). In cadaveric dissections, the septa were inserted into the bony covering of the carotid arteries in two sinuses (8.3%). Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications. Coronal tomography more successfully detects the sphenoid sinus anatomic variations.

Prevalence of Primary Tethered Cord Syndrome Associated with Occult Spinal Dysraphism in Primary School Children in Turkey

The prevalence and associated factors of primary tethered cord syndrome (PTCS) in primary school children were investigated. A cross-sectional study was performed in four demographically different primary schools in Turkey. Demographic, familial and physical data were collected from 5,499 children based on enuresis as a predominant symptom and dermatologic and orthopedic signs as clues of occult spinal dysraphism. Statistical analysis and input of the data were carried out with the SPSS package program 10.00, and logistic regression analysis was used to identify discriminating factors between enuretic children with or without neurologic signs. Of 5,499 analyzed children, 422 (7.7%) had enuresis nocturna, and 19.9% of 422 children had also daytime incontinence. Sixteen of these 422 enuretic children (3.8%) had several dermatologic signs. Five of them had spina bifida on plain radiographies, and 4 of them had cord tethering on lumbar MRI. Fifteen of 422 enuretic children (3.7%) had gait disturbances and orthopedic anomalies without cutaneous manifestations. Six of 15 children had spina bifida on plain graphies and 2 of them had tethered cord syndrome on MRI. The general prevalence of PTCS was found to be 0.1% of 5,499 analyzed children and 1.4% of enuretic children. A good outcome after untethering was found in 83.0% in this series. Practitioners should be aware of these clues of occult spinal dysraphism and resort to further radiologic and neurosurgical assessment. Early surgical intervention may halt the progression of the neurologic deficits and stabilize or reverse symptoms.

Short‐term effect of latanoprost on ocular circulation in ocular hypertension

Purpose: To determine the short‐term effects of latanoprost on retrobulbar circulation in ocular hypertension.

Assessment of sapheno-femoral junction continence in patients with primary adolescent varicocoele

BackgroundAlthough there is much evidence supporting a relationship between primary varicocoele and venous incompetence of the saphenofemoral junction in adults, there is no evidence for such a relationship during adolescence. Because of the effect of age and future occupation (standing upright for long periods) on the aetiology, pathogenesis and frequency of varicose veins of the lower extremity and incompetence of saphenofemoral junctions in adulthood, a comparison during adolescence is appropriate.ObjectiveOn the basis of a close physiopathological and haemodynamic relationship between primary varicose veins and primary varicocoele, we decided to evaluate the competence of the saphenofemoral junctions in a selected group of adolescents affected by primary varicocoele and compare these results with age-matched healthy adolescents.Materials and methodsTwenty-five adolescents with primary varicocoele and 23 age-matched healthy controls were included in the study. In all cases physical examination and colour Doppler US was used to diagnose or exclude the presence of primary varicocoele and to evaluate the continence of the saphenofemoral junction.ResultsOn the right side, 10 of 25 varicocoele patients and on the left side 11 of 25 varicocoele patients had incompetence of the saphenofemoral junction. For the control patients the incidence was 2/23 on the right side and 4/23 on the left side. The difference is statistically significant.ConclustionsWe demonstrated high concurrence of varicocoele and valvular incompetence of the saphenofemoral junction in a particular adolescent group. We suggest clinical examination and US assessment of the saphenofemoral junctions of adolescents affected by varicocoele in order to detect the early diagnosis of venous insufficiency of the lower limbs among these patients.

The effects of cyclopentolate on intraocular pressure and retrobulbar hemodynamics in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma

Purpose To evaluate the changes of intraocular pressure (IOP) and retrobulbar hemodynamics after cyclopentolate administration in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Methods Eighteen patients with pseudoexfoliation syndrome and 18 patients with pseudoexfoliation glaucoma were enrolled in the study. After baseline measurements of IOP, the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of the ophthalmic, central retinal, and posterior ciliary arteries were investigated by color Doppler imaging. Then, 1% cyclopentolate was instilled in one eye of each subject. After 45 minutes of instillation of the cyclopentolate, the measurements of IOP and retrobulbar blood flow velocities were repeated. The results were compared with those of 20 age-matched normal subjects. Results Neither IOP nor retrobulbar blood flow velocities changed significantly in control subjects after cyclopentolate administration. IOP increased significantly after cyclopentolate instillation in pseudoexfoliation syndrome (p=0.004). Retrobulbar blood velocities did not change significantly after the cyclopentolate in this group. In pseudoexfoliation glaucoma group, it was observed that basal mean IOP showed a statistically significant increase after cyclopentolate drop (p=0.002). Although blood flow velocities of ophthalmic artery did not change significantly, PSV and EDV of the central retinal and posterior ciliary arteries decreased significantly (p<0.05) and RI of the posterior ciliary artery increased significantly (p=0.01) after cyclopentolate instillation. Conclusions On the basis of our findings, pseudoexfoliation appears to be a predictive factor for an IOP rise after cyclopentolate. In pseudoexfoliation glaucoma patients, an increase of IOP after cyclopentolate could lead to a decreased retrobulbar blood flow. IOP must be rechecked after cyclopentolate administration in these patients to avoid further damage to the ganglion cells.

Evaluation of Differences Between Observers and Automatic-Manual Measurements in Calculation of Doppler Parameters

Objective. We aimed to search for differences between observers and automatic and manual measurements in calculations of Doppler parameters. Methods. The middle cerebral artery (MCA), central retinal artery, ophthalmic artery (OA), common carotid artery (CCA), vertebral artery (VA), popliteal artery (PA), interlobar renal artery (IRA), and arcuate renal artery (ARA) were evaluated in 20 healthy subjects bilaterally. Peak systolic velocity (PSV), end‐diastolic velocity (EDV), time‐averaged maximum velocity (TAMAX), resistive index (RI), and pulsatility index (PI) were measured from the same spectrum manually by 3 observers and automatically. Results of 4 measurements were compared by analysis of variance and Pearson tests. Results. The comparison of the 4 measurements revealed significant differences for most parameters except TAMAX of the OA, VA, and ARA and PSV, EDV, and PI of the PA. An automatic calculator yielded lower PSV, RI, and PI values (except the MCA and PA) and higher EDV values compared with manual measurements. The magnitudes of difference were in the range of 1% to 16% for velocities and 4% to 14% for RI and PI. The means of difference were 3.185 cm/s for PSV of the CCA and 0.054 for RI of the IRA. Correlation was high for PSV, EDV, and TAMAX in all arteries (except TAMAX of PA) and relatively low for PI and RI in most of the arteries. Conclusions. Although our study was performed on healthy subjects, our results showed that, in most cases, readers and the automatic approach disagreed on evaluation of Doppler parameters. This may be important in preventing false diagnoses in cases with Doppler values close to upper limits and may necessitate establishment of new limits for each method.

Quantitative analysis of liposuction with B mode ultrasound.

BackgroundThe objective of this study was to determine whether ultrasonography is a reliable method for monitoring subcutaneous fat thickness in the quantitative analysis of liposuction results.MethodsSubcutaneous fat thicknesses before and 2 months after liposuction in prespecified areas were measured in 14 patients using a 7.5-MHz ultrasound scanner. Pre- and postoperative subcutaneous fat thicknesses were compared statistically.ResultsThe thicknesses of pre- and postoperative subcutaneous fat layers were statistically different.ConclusionUltrasound is a valuable tool for perioperative guidance, preoperative planning, and quantitative analysis of the procedure results.

Smoking Prevents the Expected Postprandial Increase in Intestinal Blood Flow A Doppler Sonographic Study

Objective. To assess whether cigarette smoking had an effect on superior mesenteric artery postprandial blood flow. Methods. Forty‐six subjects were studied in 3 groups with Doppler sonography. Group A consisted of nonsmokers; groups B and C consisted of smokers. In group B, subjects were allowed to smoke cigarettes postprandially, whereas in group C, postprandial smoking was prohibited. A baseline Doppler evaluation was performed in the fasting state, and consecutive Doppler evaluations were performed postprandially with 30‐min intervals for 120 minutes. Doppler sonographic measurements of the superior mesenteric artery, including peak systolic and end‐diastolic velocities, resistive index, and diameter, were calculated. Statistical analysis was performed by analysis of variance. Results. All groups showed significant changes with time for all parameters (P < .001 for all). The changes in time were significantly different at 90 and 120 minutes for peak systolic velocity, at 90 minutes for end‐diastolic velocity, and at 120 minutes for diameter between groups. Group B had the greatest differences. Compared with group A, changes in peak systolic velocity at 90 to 120 minutes were significantly lower in group B (P = .007 and .006, respectively), and compared with groups A and C, changes in end‐diastolic velocity at 90 minutes (P = .006 and .004, respectively) and diameter at 120 minutes (P = .007 and .011, respectively) were significantly lower in group B. Conclusions. Smoking immediately after meals was associated with a superior mesenteric artery blood flow increase that was lower than expected, which may explain the belief that smoking reduces body weight. Postprandial smoking may have undesired results in patients with chronic intestinal ischemia.

Effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics

OBJECTIVES To determine the effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics in patients with open-angle glaucoma and to compare the results with those measured in healthy control participants. STUDY DESIGN Controlled, prospective clinical trial. SETTING University hospital. METHODS Thirty patients with open-angle glaucoma and 30 healthy volunteers as controls were topically self-administered oxymetazoline nasal spray three times a day (one spray in each nostril of 0.05% concentration) for 5 days continuously. MAIN OUTCOME MEASURES Intraocular pressure and retrobulbar hemodynamics were measured in glaucomatous and normal eyes at baseline and at the end of oxymetazoline application . RESULTS Oxymetazoline nasal spray lowered intraocular pressure significantly in both the glaucoma group (p = .02) and the control group (p = .001) after 5 days of treatment. The systemic parameters in the glaucoma and control groups (systolic blood pressure, p = .14 and p = .17; diastolic blood pressure, p = .18 and p = .49; and pulse rate, p = .06 and p = .50, respectively) did not show statistically significant differences during the study period. Additionally, except with a significant decrease in the resistivity index of the central retinal artery in the glaucoma patients (p = .001), oxymetazoline nasal spray did not result in any significant changes in the retrobulbar hemodynamics in both the glaucoma and control groups. CONCLUSIONS This study showed that a 5-day treatment with oxymetazoline nasal spray reduced intraocular pressure in both healthy controls and patients with glaucoma under treatment. In addition, it had no significant adverse effects on the retrobulbar hemodynamics.

BETTER VISUALIZATION OF VERMIFORM APPENDIX WITH TISSUE HARMONIC IMAGING COMPARED TO CONVENTIONAL SONOGRAPHY

Background: Surgery of appendicitis carries 7-11% negative appendectomy rates. Sonographically visualized normal appendix precludes unnecessary computed tomography (CT) examination and may reduce negative appendectomy rates. Tissue harmonic imaging (THI) has been reported to improve the overall image quality. Objective: We aimed to assess whether THI is more successful than conventional ultrasonography (US) in detecting normal and pathologic appendices. Patients and Methods: The study was performed on 185 patients who applied for routine US examinations in whom clinical findings of appendicitis were detected in 25. We searched for the appendix; applying both THI and conventional US to each patient, one before and the other after the routine US examinations. Patients were divided into two groups; one was evaluated first with conventional US and the other first with THI. When the appendix was found, localization, diameter and time spent for visualization were recorded. Twelve patients were operated; all of whom had appendicitis pathologically. Two methods were compared for: 1. Success rates in all patients; female, male and child groups separately; 2. Visualization of pathologic and normal appendices; 3. Time for visualization of appendix; 4. Comparison of success rates in the adult and child population. The relationship between the rate of visualization and body mass index was evaluated. Results: The appendix was visualized better by THI in all patients, and in the female and male groups (P < 0.001). In children, both methods were more successful compared to adults (P < 0.001, compared to male group, P < 0.001, compared to female group), with no difference between the methods (P = 0.22). When only the normal appendices were concerned, there was significant difference between both methods (P < 0.000). Both methods detected pathologic appendices better than normal ones, with a higher ratio for THI (P = 0.022 for the THI group, and χ2 = 7.22, P = 0.07 for the conventional US group). THI visualized the appendix faster. Both methods were more successful in lean patients (P = 0.004 for THI, P = 0.001 for conventional US imaging). Conclusions: THI visualizes appendix better than conventional US. It is a simple and time saving method that may eliminate further diagnostic imaging, and it may decrease negative appendectomy rates and related complications.