Gürhan Adam

Cesarean Scar Pregnancy Diagnosis, Management, and Follow-up

Cesarean scar pregnancy is a very rare form of pregnancy and a life‐threatening situation. It has become an important and serious problem over the last 10 years, as a result of the worldwide increase in cesarean births. In this retrospective series, the diagnosis of cesarean scar pregnancy, management, treatment methods, risk factors, and possibility of subsequent normal pregnancy are discussed, and case descriptions are presented.

Evaluation of Platelet Distribution Width and Mean Platelet Volume in Patients With Carotid Artery Stenosis

Platelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.

Retrograde intrarenal surgery in pediatric patients.

Urinary tract stone disease is seen at a level of 1%-2% in childhood (< 18 years). In recent years, however, there has been a marked increased in pediatric stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to todays advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging.

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

The Usage of 2 and 3-Dimensionel Ultrasound in Prenatal Diagnosis of Sacrococcygeal Teratoma: Report of a Case

DOI: 10.4328/JCAM.2055 Received: 17.09.2013 Accepted: 01.10.2013 Printed: 01.10.2013 J Clin Anal Med 2013;4(suppl 2): 123-5 Corresponding Author: Ahmet Uysal, Çanakkale Onsekiz Mart Üniversitesi, Kadın Hastalıkları ve Doğum ABD, Çanakkale, Türkiye. T.: +905332635540 E-Mail: drahmetuysal@hotmail.com Özet Sakrokoksigeal teratom 1:40.000 canlı doğum prevalansı ile tüm fetal tümörlerin yarısını oluşturmaktadır. Sıklıkla benign davranışlı olmasına rağmen, kalp yetmezliği ve hidropsa neden olması mortalite ve morbidite oranını yükseltmektedir. Kötü prognoza neden olan faktörler kitlenin solid komponentinin fazla olması ve 30 haftadan önce hidrops gelişmesidir. Prenatal dönemde B mod, renkli Doppler ultrasonografi ve üç boyutlu ultrasonografi (3B US) ile lezyonun karakterizasyonu yapılabilmektedir. 27 yaşında G2P1 gebeye yapılan obstetrik ultrasonografik değerlendirmede, biometrik ölçümlere göre 18. haftalık kız fetusta, sakrokoksigeal bölgede, 22x23 mm boyutlarında, düzgün sınırlı, heterojen ekojen içyapıda kitlesel lezyon saptandı. Ailenin gebeliğin devamını istemi ile gebelik terme kadar yakın takip edildi. Tümörün ani hızlı büyümesi nedeniyle, fetal hidrops veya plasentomegali gibi komplikasyonlar gelişmemişken gebeliğin 36. haftasında sezaryen ile komplikasyonsuz olarak doğum gerçekleştirildi. Operasyon sonucu histopatolojik değerlendirmede sakrokoksigeal bölgedeki kitlesel lezyon immatür teratom olarak raporlandı.

Re: Imaging the urologic patient: the utility of intravenous pyelogram in the CT scan era

We read with great interest the recent article by Hale et al. [1] on the comparative study of intravenous urography (IVU) and computerized tomography (CT). They concluded that IVU has a limited clinical role on the evaluation of the urologic patient, and thus, its use should be strictly limited to highly select cases. We congratulate the authors for their work and thank them for bringing this important topic to our attention; however, we feel that some issues described in their paper need further discussion. We know that noncontrast CT is the most accurate imaging method for identifying urinary stones, and it has become the standard test for diagnosis of acute flank pain [2]. It offers the advantages over IVU of avoiding contrast allergy or nephrotoxicity and has ability to determine the other causes for abdominal pain. However, most of the patients with a history of flank pain return with similar symptoms and need to undergo repetitive CT examinations. Furthermore, current EAU guidelines recommend a contrast study (enhanced CT or IVU) if stone removal is planned, because the anatomy of the renal collecting system needs to be assessed prior to stone surgery or shock wave lithotripsy [2]. But use of repeated CT or IVU would increase the risk of cancer development. Epidemiological trials have reported an association between doses of radiation administered in CT and an increased risk of malignancy [3]. Recently, published studies also reported a theoretic increased risk of fatal cancer in pediatric and adult population as a result of single CT scan, based on data from similar levels of exposure to radiation during the atomic bombings of Nagasaki and Hiroshima [4, 5]. It was underlined that a single abdomen CT in infants would cause in one CT-related death per 550 scans [6]. Therefore, we believe that combination of ultrasonography and abdominal radiography may be considered in the evaluation of acute flank pain especially in children and patients with known urinary stone disease. Noncontrast CT may be reserved for those patients with suspected urolithiasis but negative findings on plain radiography and ultrasonography.

Symptomatic Spinal Migration of Subarachnoid Hemorrhage due to Ruptured Intradural Vertebral Artery Aneurysm

A 55‐year‐old patient was admitted to the hospital with severe acute back pain. Thoracolumbar magnetic resonance (MR) imaging showed hemorrhage in subarachnoidal‐subdural space. On cranial MR imaging and MR angiography, an aneurysm was suspected in the V4 segment of the right vertebral artery. Angiography showed a fusiform dissecting aneurysm in the V4 segment of right vertebral artery. The final diagnosis was ruptured V4 segment aneurysm with subsequent symptomatic migration of hemorrhage into the spinal subarachnoidal‐subdural space. The patient was treated endovascularly by coil occlusion of both the aneurysm and vertebral artery. This rare cause and possible mechanisms for spinal migration of intracranial hemorrhage after aneurysmal rupture is discussed.

Agenesis of Submandibular Glands: A Report of Two Cases with Review of Literature

Background. Congenital absence of the submandibular gland (SMG) is a rare condition. Although complaints such as dry mouth, dental problems, or difficulty in swallowing may be seen, the subjects may also be asymptomatic. The absence of the SMG may be associated with hypertrophy of the contralateral SMG. Case Report. We report the case of a 44-year-old woman with incidentally detected left SMG aplasia, with contralateral SMG hypertrophy mimicking a mass, and the case of a 46-year-old woman with incidentally detected bilateral SMG aplasia, demonstrated by computerized tomography (CT) and magnetic resonance imaging (MRI). Conclusion. It is important for the clinician to know that this very rare abnormality may exist. When such a case is encountered, symptoms and findings should be reevaluated and, if necessary, conservative therapy should be initiated. The possibility of observing additional deformities should be kept in mind and an evaluation should be done for other cases in the family.

The association of urolithiasis and androgenetic alopecia

Abstract Objectives: The objective of this study is to investigate whether patients with androgenetic alopecia were at risk in terms of urinary system stone disease. Patients and methods: Patients with no baldness (Hamilton–Norwood Scala [HNS] stage I) were categorized as Group I, those with hair loss in the frontal region (HNS stages II, III, IIIa, and IVa) as Group II, those with hair loss in the vertex region (HNS stage III-vertex, V) as Group III and those with hair loss in both vertex and frontal regions (HNS stages IV, Va, VI, and VII) as Group IV. Patients in all groups were compared in terms of presence of stone, and the presence of any association between alopecia and urolithiasis, with common etiological risk factors, was investigated. Results: Three hundred and two male patients were included in the study. The presence of urolithiasis was detected in 28.9% of patients in Group I; 26.5% of Group II; 36.9% of Group III; and 44.4% of Group IV (p = 0.085). Among patients aged under 60, urinary stone disease was detected in 30.8% of patients in Group I; 26.4% of Group II; 41.2% of Group III; and 53.8% of Group IV (p = 0.001). In patients aged over 60, urolithiasis was detected in 12.5% of patients in Group I; 26.9% of Group II; 32.2% of Group III; and 37.8% of Group IV (p = 0.371). Conclusions: We determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old.

Evaluation of serum L-FABP levels in patients with acute pancreatitis.

BACKGROUND The aim of this study was to assess the serum L-FABP levels in patients with acute pancreatitis and compare with healthy subjects. METHODS Thirty patients with acute pancreatitis and thirty consecutive healthy age- and sex-matched control subjects were included into the study. The serum levels of L-FABP were measured upon admission and at the remission period. RESULTS Upon admission, serum L-FABP concentration was significantly higher in patients with acute pancreatitis compared to control subjects (41009.41 ± 32401.31 pg/ml vs. 17057.00 ± 5015.74 pg/ml, p=0.008). Serum L-FABP levels decreased after the remission period; however, the differences were not statistically significant. In addition, serum L-FABP levels showed significant correlation with AST and LDH levels. CONCLUSION Increased serum L-FABP levels may be related to the mechanism of pancreatic microcirculatory disturbance in patients with acute pancreatitis, suggesting that serum L-FABP could be used for a potential biomarker of acute pancreatitis.