Bumin Degirmenci

Are There Adverse Effects of Herniorrhaphy Techniques on Testicular Perfusion? Evaluation by Color Doppler Ultrasonography

Purpose: To evaluate the efficacy of prosthetic meshes on testicular perfusion using color Doppler ultrasound (CDUS). Materials and Methods: This study is a randomized prospective clinical trial with blind assessment of outcome. A total of 26 patients who underwent elective herniorrhaphy for groin hernia participated in the study. Each patient was randomly assigned to 1 of 2 groups: totally extraperitoneal preperitoneal hernia repair (TEP; n = 13, mean age 46.7 ± 1.6 years) or Lichtenstein hernia repair (LHR; n = 13, mean age 54.2 ± 2.7 years). Six of the patients had bilateral hernias (n = 3 for each group). Blood flow indexes of the spermatic artery including end diastolic velocity (EDV), peak systolic velocity (PSV) and the resistive index (RI) were examined by CDUS. Ultrasound was performed just before the operations and repeated after 3 months. Kruskal-Wallis and Mann-Whitney U tests were used to evaluate the differences. Results:No statistically significant differences were found between the preoperative and postoperative measurements which included blood flow parameters (PSV, EDV, and RI) of the testes (p > 0.05). Conclusion:Neither the TEP or LHR technique had any decreasing effect on blood flow.

CT Findings of Patients with Small Bowel Obstruction due to Bezoar: A Descriptive Study

Purpose. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types. Materials and Methods. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. Results. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum (n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. Conclusions. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis.

Agenesis of sphenoid sinus: three cases

Paranasal sinus agenesis is an unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of the sphenoid sinus is extremely rare. This report presents three new cases of sphenoid sinus agenesis. The absence of the sphenoid sinus was demonstrated by computed tomography (CT) in all cases.

Klippel-feil syndrome associated with pneumatocyst of the right cervical rib

A patient with Klippel-Feil syndrome reported with a pneumatocyst of the proximal epiphysis of a right cervical rib. There was no additional skeletal abnormality except for fusion of the C3 and C4 vertebral bodies. To the best of our knowledge, this is the first reported instance of this particular association.

Effects of Sildenafil Citrate (Viagra®) on Renal Arteries: An Evaluation with Doppler Ultrasound

Introduction: We aimed to determine hemodynamic alterations in renal arteries that may have resulted from oral intake of sildenafil citrate in healthy volunteers. Materials and Methods: Twelve healthy volunteers were included in our study. Renal Doppler ultrasonography (US) was performed before the drug intake to assess the basal values. Maximum peak systolic velocity, and resistivity and pulsatility indices were measured from the segmental branches of both renal arteries in all the ex- aminations. After the basal measurements 50 mg of sildenafil or placebo were randomly given to the 12 subjects. Renal Doppler US examinations were carried out 1 h after sildenafil or placebo intake. On the following day sildenafil was administered to the subjects who had previously taken placebo or vice versa. Renal Doppler US was repeated after 1 h. The effect of sildenafil on renal vascular hemodynamics was evaluated by comparison of basal values with postplacebo and postsildenafil values. Results: No statistically significant differences were found between the basal values of bilateral renal arteries and maximum peak systolic velocity, and resistivity and pulsatility index values measured after the placebo or sildenafil intake. Conclusion: We demonstrated that single-dose sildenafil did not cause any significant effect on renal artery hemodynamics in healthy individuals.

Sonographic Findings of Median Nerve and Prevalence of Carpal Tunnel Syndrome in Computer Mouse Users

The purpose of this study was to evaluate the median nerve sonographically and estimate the prevalence of carpal tunnel syndrome (CTS) in computer mouse users. Forty-nine right wrists of 49 employees who had used a computer mouse were included in the study. Thirty-three right wrists of 33 non-mouse user employees were studied as a control group. Both the mouse user and non-mouse user employees underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained proximally, in the middle and distally in the carpal tunnel. At each level, flattening ratio and the cross-sectional area of the median nerve were calculated. We found no significant difference in any parameters between mouse users and control group (p>0.05). However, when we compared mouse users according to the presence of pain, there was a significant increase in the cross-sectional area of the median nerve proximally in the mouse users having pain (p<0.05). Of all mouse users, eight (16.3%) were diagnosed as sensory CTS, four (8.2%) as motor CTS by EMG. We also found that four (50%) CTS patients had a proximal cross-sectional area of median nerve exceeding 10 mm2 and five (62.5%) had a distal flattening ratio over three. Prolonged use of a mouse may pose an occupational risk for employees. Sonography can serve as an initial step in symptomatic patients for diagnosis of CTS.

Effect of Aerodiol administration on ocular arteries in postmenopausal women

Objective. The aim of the present study was to evaluate the alteration of ocular blood hemodynamics after intranasal administration of 17β-estradiol, through measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) using color duplex sonography. Methods. Thirty healthy women who had been naturally postmenopausal for at least 1 year were enrolled in the study. A randomized, placebo-controlled, crossover, double-blinded study was conducted of the acute effect of 17β-estradiol (Aerodiol®; Servier, Chambrayles-Tours, France) on OA and CRA blood flow using color duplex sonography. Results. The peak systolic and end diastolic velocities of the CRA were increased significantly after 17β-estradiol administration compared with placebo. A significant decrease was also found in the pulsatility and resistive indices of the CRA. However, there were no statistically significant differences in OA flow velocities or pulsatility and resistive indices. Conclusions. Nasal 17β-estradiol administration in postmenopausal women causes an improvement in the ocular vascular Doppler indices. These results suggest that there could be a positive effect of Aerodiol® on middle-sized arteries and arterioles.

Percutaneous resection of a patellar osteoid osteoma using a cannulated skin punch biopsy needle

Patella is a very rare localization for osteoid osteoma. Non-specific knee complaints and difficulty to distinguish nidus in direct radiographs may cause a delay in diagnosis and make the definite diagnosis troublesome. The most effective and non-invasive method in treatment of osteoma is CT guided excision of the nidus. We present a case of patellar osteoid osteoma diagnosed by MRI scans. After being marked under CT guidance, the lesion was completely excised with a skin punch. We propose that, this method is both minimal invasive and effective in the management of patellar osteoid osteoma.

Effect of sildenafil citrate on postprandial gallbladder motility.

Objective: Sildenafil stimulates the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway through inhibition of type 5 phosphodiesterase. NO-cGMP pathway causes smooth muscle relaxation. The aim of this study is to evaluate the effects of sildenafil on gallbladder motility. Methods: Twenty healthy male volunteers (21–35 years old) participated in this randomized, double blind, crossover, and placebo-controlled study. Oral sildenafil (50 mg) or placebo was randomly dispensed to each volunteer on two consecutive days. After the sildenafil or placebo, a special meal with a high fat content was administered. Gallbladder volume was measured using sonography preprandially and at 5, 15, 30, 60, 120 and 180 minutes postprandially. Results: Sildenafil showed an inhibitory effect on gallbladder contraction in healthy volunteers that began at 30 minutes. Gallbladder volumes showed significant differences at 30 minutes following the test meal (approximately 50-60 min after the sildenafil intake), between placebo (15.4 ± 5.1 mL) and the sildenafil groups (19.3 ± 6.1 mL) (P < 0.05). In addition, gallbladder volume was significantly higher during the refilling phase in the sildenafil group (P < 0.05 at 180 min). Maximal contraction was achieved at 60 minutes in each group. Conclusions: Sildenafil constituted a significant inhibitory effect on gallbladder discharge in healthy individuals when compared with placebo group. Because of this inhibitory effect, sildenafil consumption for long periods may potentiate risks of gallbladder disorders and gallstone formation resulting from disturbed gallbladder motility.

A case of achalasia presented with cardiopulmonary arrest.

Achalasia is a rare disorder characterised by obstruction of the distal oesophagus and subsequent dilation of the proximal oesophagus. Patients generally complain of gastrointestinal symptoms; however, pulmonary symptoms and complications may also occur. A 35-year-old woman was brought to our emergency service complaining of sudden-onset dyspnea that started 15 minutes earlier during dinner. She suffered a cardiopulmonary arrest due to aspiration 5 minutes after being admitted to the emergency room and was intubated. Thoracic computed tomography examination showed that her oesophagus was filled with undigested food. Heller cardiomyotomy and Dor fundoplication was performed via laparotomy with the diagnosis of primary achalasia, and she was discharged as uneventful on the 5th postoperative day.