Fahri Halit Besir

Do energy drinks cause epileptic seizure and ischemic stroke

Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wifes testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach. He did not have a history of seizures, head trauma, or family history of seizures or another disease. In cranial diffusion magnetic resonance imaging, there were hyperintense signal changes in bilateral occipital area (more pronounced in the left occipital lobe), right temporal lobe, frontal lobe, and posterior parietal lobe. All tests associated with possible etiologic causes of ischemic stroke in young patients were negative. Herein, we want to attract attention to adverse effect of energy drink usage.

The results of computed tomography guided tru-cut transthoracic biopsy: complications and related risk factors

ZusammenfassungEINLEITUNG: Die transthorakale Biopsie (TTB) ist eine gut definierte und effiziente Methode zur Gewinnung von Gewebe für die histopathologische Diagnose pulmonaler Läsionen. Sie ist weniger invasiv als chirurgische Verfahren und hat eine bessere diagnostische Aussagekraft als Fein-Nadel-Biopsien (FNAB), vor allem bei der Beurteilung benigner Läsionen. In der vorliegenden Studie präsentieren wir unsere mit TTB erhobenen Ergebnisse, sowie die Komplikationen beziehungsweise die damit verbundenen Risikofaktoren. MATERIAL UND METHODEN: 102 Patienten, bei denen zwischen Jänner 2003 und Dezember 2007 pulmonale Läsionen mittels CT gezielter TTB evaluiert wurden, sind in die Studie aufgenommen. TTB assoziierte Komplikationen wurden festgehalten. Faktoren, wie die Tiefe und Größe der Läsion, sowie das Ausmaß eines um die Läsion bestehenden Emphysems wurden mit χ2-Test evaluiert. ERGEBNISSE: Von den gewonnenen Gewebeproben waren 51 % histopathologisch malign und 49 % benign. Bei 15,7 % der 102 Prozeduren entstand ein Pneumothorax. Das Risiko der Entwicklung eines Pneumothorax stieg signifikant mit dem Abstand der Läsion von der Pleura, mit der Größe der Läsion, sowie mit dem Ausmaß emphysematöser Veränderungen rund um die Läsion. SCHLUSSFOLGERUNG: Die Komplikationsrate der TTB ist mit der der FNAB vergleichbar. In Zentren, wo die zytologische Diagnostik von pulmonalen Läsionen insuffizient ist, empfehlen wir die routinemäßige Anwendung der CT-gezielten TTB, da diese ebenso verlässlich ist, wie die FNAB.SummaryINTRODUCTION: Transthoracic biopsy (TTB) is a well-defined and effective method used for pathologic sampling in the diagnosis of the pulmonary lesions. It is less invasive in comparison to surgical procedures. In addition, diagnostic rate of tru-cut biopsy is higher than that of fine needle aspiration biopsy (FNAB) especially for benign lesions. In this study, we presented tru-cut transthoracic biopsy (TTB) procedure results and the frequency of TTB complications with related risk factors. MATERIAL AND METHODS: A total of 102 patients were evaluated by CT scan guided tru-cut TTB in the diagnosis of lung lesions between January 2003 and December 2007. The complications due to tru-cut TTB were recorded. The factors such as the lesion depth, the lesion size, and the emphysematous changes that accompany the lesion were evaluated through χ2 test. RESULTS: Among the samples, 51% malignancy and 49% benign pathology were observed. Pneumothorax developed in 15.7% of the 102 procedures. It was found that the lesions distance from the pleura, the size of the lesion, and emphysematous changes around the lesion significantly increased the risk of pneumothorax. DISCUSSION: The tru-cut biopsy complications are similar to those of FNAB. In the centers where cytologic examination is insufficient in the diagnosis of lung lesions, tru-cut biopsy should be routinely performed as it is a reliable biopsy technique compared to FNAB.

The Evaluation of Atherosclerosis in Migraine Patients

Abstract  A potential association might exist between atherosclerosis and migraine. Carotid intima‐media thickness (CIMT) is a marker of generalized atherosclerosis; hence, we aimed to assess CIMT in migraine patients. This study included 30 patients and 60 healthy controls aged between 20 and 40 years. Episodic migraine diagnosis was made according to the criteria of International Headache Society (IHS). Healthy controls who do not suffer any headache problems were selected from among hospital and laboratory staffs. All subjects were evaluated regarding some parameters and features known to be associated with migraine and vascular changes, that is, gender, age, body mass index, blood pressure, cholesterol, smoking habits, used hormonal contraceptives, and history of disease. The left common carotid arteries of the subjects were examined, and CIMT was measured with real‐time gray‐scale sonography. Mean values and standard deviations were calculated. All measurements were made in migraine‐free periods. Migraine patients and control subjects were well matched for those parameters known to be associated with vascular changes, that is, gender, age, BMI, blood pressure, and cholesterol. CIMT values were higher in patients. The results showed that the mean CCA IMT values were 0.493 ± 0.074 mm and 0.409 ± 0.053 mm in migraine patients and controls, respectively (P < 0.001). There is a relationship between atherosclerosis and inflammation in migraine patients. The risk of cranial inflammatory arteriopathy increases in repeated attacks of migraine. Our study also supports that high number of attacks and attack duration are important in the development of atherosclerosis.

Normal values correlates' of carotid intima- media thickness and affecting parameters in healthy adults

OBJECTIVE Early changes in atherosclerosis can be diagnosed by the carotid artery intima-media thickness (CIMT) measurement. Normal range of CIMT in healthy subjects has not been studied yet in our country. Therefore, the aim of this study was to measure the CIMT in healthy individuals and investigate affecting parameters of CIMT. METHODS Overall, 2298 subjects, aged 18 to 92 years were undergone CIMT measurement in this observational cohort study. 151 healthy adult subjects, aged 20 to 79 year without atherosclerotic risk factors, normal body mass index and normal metabolic parameters were selected to establish normative CIMT values. Correlations between CIMT and atherosclerotic risk factors were evaluated in the Turkish population. The independent variables associated with CIMT were evaluated with multiple linear regression analysis. RESULTS CIMT value was 0.458 ± 0.116 mm in males and 0.47 ± 0.104 mm in females. Mean values of CIMT (in mm) for healthy reference sample aged 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years were 0.402; 0.466; 0.492; 0.586; 0.692 and 0.733, respectively. CIMT increased significantly (p<0.001) by 0.066 mm, in every decade. Correlates of CIMT were age, visceral fat level, fasting serum glucose, total and low-density lipoprotein cholesterol. Multiple linear regression analysis revealed that age was the single independent predictor of CIMT thickness in healthy individuals (β=0.007, 95% CI: 0.006-0.008, p<0.001). CONCLUSION CIMT was 0.458 ± 0.116 mm in men and 0.47 ± 0.104 mm in Turkish healthy adults. Age was the only predictor of CIMT. CIMT measurement can be used in the assessment of early atherosclerosis burden in adults.

Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment.

Context: Retroperitoneal hematoma may usually occur as a result of trauma. A life threatening retroperitoneal hematoma is not expected complication of anticoagulation treatment and rarely reported. Low molecular weight heparins (Enoxaparin) which are used as effective and safe medicine in the venous thromboemboly treatment have some major complications such as hematomas of different organs. We aim to present a giant spontaneous retroperitoneal hematoma after anticoagulant treatment of pulmonary embolism with enoxaparin. Case Report: A 73-year-old male patient with the diagnosis of pulmonary embolism underwent anticoagulant treatment (enoxaparin). In the second day of admission, the patient had an episode of abdominal and back pain. Abdominal ultrasonography and computerized tomographic scan revealed a giant retroperitoneal hematoma. Enoxaparin treatment was then stopped and the supportive treatment was started. In the following days, hemoglobin levels returned to normal and a control CT revealed regression of hematoma size. Conclusion: The anticoagulant treatment with enoxaparin may lead to severe hematomas. Therefore, the clinical suspicion is required especially in elderly patients and patients with impaired renal function for retroperitoneal hematoma, when they suffer from acute abdominal pain.

The benefit of expiratory-phase quantitative CT densitometry in the early diagnosis of chronic obstructive pulmonary disease.

PURPOSE We aimed to compare the inspiratory and expiratory quantitative computed tomography (CT) densitometric data of healthy volunteers, individuals with chronic obstructive pulmonary disease (COPD) risk, and COPD patients to aid in the early diagnosis of COPD. MATERIALS AND METHODS Of the study patients, 14 were healthy volunteers (Group I), 12 were patients at risk for COPD (Group II), and 13 were COPD patients (Group III). The high-resolution CT was performed at three levels (the upper, middle, and lower parts of the lungs). All images were evaluated with a specific program for the segmentation of pulmonary parenchyma. The mean lung density (MLD) was measured, and the emphysema index (EI) was calculated using this program. RESULTS Both MLD values and calculated EI ratios showed significant differences between Groups I and III, and Groups II and III in both expiratory and inspiratory phases (P < 0.05). However, in the comparison of healthy volunteers and patients at risk for COPD (Group I and II), only expiratory-phase MLD values showed statistically significant difference (P < 0.001). CONCLUSION In patients at risk for COPD, expiratory-phase MLD measurements can be used as an early diagnostic method.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis

Abstract Purpose: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. Methods: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV–EDV)/PSV]. Results: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. Conclusion: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Giant Myoepithelioma of the Soft Palate

Myoepitheliomas are benign salivary gland tumors and account for less than 1% of all salivary gland tumors. They are usually located in the parotid gland. The soft palate is very rare affected site. The differential diagnosis of myoepitheliomas should include reactive and neoplastic lesions. The treatment of myoepitheliomas is complete removal of the tumor. Herein, we report a case with giant myoepithelioma of the soft palate, reviewing the related literature.

Avulsion Fracture of the Anterior Inferior Iliac Spine in a Soccer Player

A 14-year-old male soccer player presented with left groin pain that had started suddenly after kicking the ball during a soccer game the day before. His pain was aggravated during the swing phase of walking and active flexion of the hip. Inspection revealed no swelling or erythema in the inguinal area. Moderate tenderness was noted upon palpation of the right inguinal region. Passive range of motion of the right hip was normal except for limited hip extension. Weakness in hip flexion was attributed to pain. An anteroposterior radiograph of the pelvis showed a displaced avulsion fracture of the anterior inferior iliac spine (AIIS; Figure 1). This finding was confirmed by a pelvic computed tomography scan that revealed a crescent-shaped bone fragment displaced inferiorly about 1.5 cm from the right AIIS (Figure 2). Avulsion fractures of the pelvic apophyses are very uncommon and almost always occur in adolescents before their growth plates close [1]. The most typical locations are the anterior superior iliac spine, AIIS, and ischial tuberosity [2]. These fractures may be overlooked and can be easily confused with an insertional tendinitis or musculotendinous tear. Patient history, as in this case, demonstrates the typical mechanism of injury involving a sudden and forceful muscular contraction during sport activities. The avulsion of the AIIS occurs after forceful contraction of the rectus femoris muscle. The most commonly reported mechanisms are kicking and running [2,3]. Treatment of avulsion fractures of the pelvic apophyses includes surgical and nonsurgical interventions. Surgical treatment, primary open reduction, and internal fixation may be warranted when the fragment is displaced greater than 2 cm or the ischial tuberosity is involved [3]. This young athlete was treated conservatively with 3 weeks of non–weightbearing activity, 3 weeks of partial weight-bearing activity, and then a gradual return to full

The Rapid Pull-Back Technique for Navigation across a Wide-Necked Aneurysm: A Report of Four Cases

Embolization of wide-necked and/or giant aneurysms may fail due to the inability to pass across the aneurysm neck. We describe the rapid bull-back technique used in four patients in which a small diameter microcatheter with the aid of a hydrophilic microguidewire was navigated along the inner surface of the aneurysm, making a loop in the dome, exiting the neck to reach distal intracranial vessels. After withdrawal of microguidewire, the microcatheter is pulled back rapidly up to a predetermined length. This maneuver results in elimination of the loop, straightening the microcatheter to allow an exchange procedure for another device to cross the neck distally and continue the embolization procedure. The rapid pull-back technique is useful during the endovascular treatment of wide-necked and/or giant aneurysms as it helps to achieve reliable access to the distal parent vessel with the microcatheter. This is of increasing importance since an increasing number of aneurysms will be treated in the future with refinements in various intracranial stents.