Guven Tekbas

Deep neck space infections: a retrospective review of 173 cases

PURPOSE The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. MATERIALS AND METHODS The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. RESULTS Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. CONCLUSION Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.

Diameters of the common bile duct in adults and postcholecystectomy patients: A study with 64-slice CT

This study aims to collect data by multidetector computed tomography (MDCT) on the diameter of the normal common bile duct (CBD) and the diameter of CBD after cholecystectomy. In this retrospective study, CBD measurements were performed on axial oblique images, perpendicular to the long axis of the distal CBD. The mean diameter of the normal CBD was measured in 604 patients without cholecystectomy. The patients were divided into 6 groups according to their age. Analysis of variance (ANOVA) was used to compare data obtained from the six age groups. The mean diameter of the CBD of 46 patients who had cholecystectomy was calculated. The results were compared with age matched control group by Students t test. The largest diameter of CBD ranged from 1.8 to 11.8mm. The mean of the largest diameter of 604 subjects was 4.77 ± 1.81. The diameter of the CBD significantly increased with age. Mean largest CBD diameters of postcholecystectomy subjects (7.28 ± 2.37) were significantly greater than age matched control group. In conclusion the diameter of CBD shows a considerable increase with age. The largest diameter of the CBD is up to 6mm in most of the subjects. An upper limit of 8mm appears reasonable after the age of 50; and an upper limit of 10mm seems appropriate for cholescystectomized subjects.

A serious medicolegal problem after surgery: gossypiboma.

AbstractAfter surgery, the most common foreign bodies retained in the abdominal cavity are the surgical sponges. The aim of the present study was to emphasize the importance of gossypiboma, which is a serious and medicolegal problem. The records of 12 patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital were retrospectively reviewed between January 1994 and December 2009. Eight of the 12 patients were females, and 4 were males. Previously, 7 patients had been operated on electively, and 5 had undergone operations on an emergency basis. Abdominal ultrasonography clearly demonstrated gossypibomas in 5 patients, and computed tomography demonstrated a more precise image of retained surgical sponges in 3 patients. One patient died because of ventricular fibrillation; the other 11 patients were discharged in good health. To eliminate the risk of gossypibomas, all sponges should be counted at least twice (once preoperatively and once postoperatively); use of small sponges should be avoided during laparotomy, and only sponges with radiopaque markers should be used. The surgeon should explore the abdomen before closure. In cases in which the sponge count is uncertain, an abdominal x-ray should be performed before closure.

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography.

ZusammenfassungDie Lungenvenen sind eine der bedeutendsten Strukturen des Kreislaufs. Im letzten Jahrzehnt wurde erkannt, dass die Lungenvenen eine bedeutende Rolle beim Vorhofflimmern als auslösender Fokus der elektrischen Aktivität spielen. Die primäre Behandlungsmethode des Vorhofflimmerns ist die Ablation des Fokus in den Lungenvenen. Für den besten Erfolg dieser Maßnahme sollte die Anatomie der Lungenvenen vorher gut bekannt sein. MATERIAL UND METHODEN: In unserer Abteilung für Radiologie wurde zwischen Jänner 2008 und Mai 2010 bei 783 Patienten eine computertomographische Angiographie durchgeführt. Die Patienten waren zur Coronar-CT wegen einer bekannten oder suspizierten koronaren Herzerkrankung, bzw. zur CT Angio wegen des Verdachtes auf Pulmonalembolie zugewiesen worden. Alle Untersuchungen wurden auf einem Phillips Brilliance 64 Zeiler Multidetektor CT Gerät durchgeführt. 402 der Patienten waren männlich, 381 weiblich. Das mittlere Alter der Patienten lag bei 48 (14–89) Jahren. Die CT Ergebnisse zur Identifikation der Anatomie der Lungenvenen (inklusive ihrer Varianten und Anomalien) wurden retrospektiv erhoben. ERGEBNISSE: Bei dem Großteil der Fälle mündeten zwei Lungenvenen in den linken Vorhof auf jeder Seite. 18 Variationen wurden rechts und 8 Variationen links entdeckt. Die häufigste kombinierte Variante waren 2 rechts und 4 links (32,3 %) einmündende Lungenvenen. Vier links einmündende Lungenvenen war der häufigste Einfach-Variations Typ (76 %). Zusätzlich wurden ein Situs inversus totalis (0,12 %), 2 partiell anormale pulmonal venöse Rückströme (0,25 %) und ein Szimitar Syndrom (0,12 %) gefunden. SCHLUSSFOLGERUNGEN: Diese Studie zeigt, dass viele Variationen der Lungenvenen mit zunehmender Patientenzahl beobachtet werden. Um eine erfolgreiche und komplikationslose Ablation bzw. Operation zu gewährleisten, sollte die Anatomie der Lungenvenen vor der Prozedur bekannt sein. Die Multidetektor CT ist eine verlässliche bildgebende Methode für die Erfassung der Querschnitts und 3-dimensionalen Anatomie.SummaryPulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14–89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.

Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome

OBJECTIVES The present study aimed to present the clinical and multidetector computed tomography (MDCT) findings of patients who were diagnosed with the median arcuate ligament (MAL) syndrome on MDCT retrospectively. METHODS Seven hundred forty-four patients in whom MDCT angiography was performed were retrospectively analyzed for investigating incidental MAL syndrome. RESULTS Twenty-one patients were shown to have MAL syndrome. Of 21 patients, 18 with MAL syndrome were asymptomatic. Three patients had some symptoms. On MDCT angiography, proximal narrowing of the arteries was observed in 21 patients. CONCLUSIONS MDCT is a minimally invasive and useful tool for the diagnosis of MAL syndrome.

Percutaneous Cholecystostomy in High-Risk Elderly Patients With Acute Cholecystitis: A Lifesaving Option

Purpose: To analyze the results of percutaneous cholecystostomy in in high-risk elderly patients with acute cholecystitis. Materials and Methods: Between June 2010 and May 2011, 11 patients aged over 60 who had at least 1 systemic disease and underwent percutaneous cholecystostomy were reviewed retrospectively. Results: The procedure was technically successful in 10 (90.9%) patients. Clinical improvement was achieved in 81.8% of patients within 72 hours. Two patients received emergency surgery while elective cholecystostomy was performed in 5 patients. Percutaneous cholecystostomy was performed singly in 4 (36.4%) patients. Early complication rate was 18.2%. Two (18.2%) patients died. Conclusion: Percutaneous cholecystostomy can be performed with low mortality and morbidity. Cholecystectomy should be performed in all patients with suitable general conditions due to the high recurrence rates of percutaneous cholecystostomy.

Variations of Renal Artery in 820 Patients Using 64-Detector CT-Angiography

Purpose: Renal artery variations are important for clinical reasons. The aim of this study is to determine the originating level and variations of renal arteries with 64-channel multidetector computed tomography (MDCT). Materials and methods: In a university hospital, 820 patients who underwent MDCT angiography of the abdominal aorta were retrospectively evaluated. The number, early division (ED), and originating level of renal artery were evaluated retrospectively. Variations of the renal artery on both sides, the difference between the genders with variations of the renal artery, were compared with chi-square test. Results: Renal artery originating from the level of L1–L2 intervertebral disc was found in 37.0% and 38.9% of patients on the right and left sides, respectively. Renal artery variations, including extrarenal artery (ERA), were found in 27% and ED in 26.7% of the patients. Significant differences were found in ED and ERA prevalence for genders (p = 0.006 and p = 0.043, respectively). The prevalence of both variations is higher in males. Conclusions: An awareness of renal vascular variations is very important for both surgeons and radiologists. In this series, renal arterial variations were found in approximately one-fourth of the study population.

US-guided percutaneous thrombin injection of postcatheterization pseudoaneurysms.

PURPOSE This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms. MATERIALS AND METHODS Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed. RESULTS Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications. CONCLUSION US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions

Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions.

Display with 64-detector MDCT angiography of cerebral vascular variations

PurposeThe aim of this study was to assess the cerebral variations and observe their frequency in the patients who have undergone angiographies with the state of the art 64-slice multidetector computed tomography (MDCT) angiography technique due to various reasons.Methods500 patients (253 women, 247 men) who had CT scan in the period of April 2008 to March 2010 at Dicle University Medicine Faculty Hospital Radiology Unit were surveyed in this study. Patients who had CT scan with brain CT angio protocol were evaluated using multiplanar, maximum intensity projection (MIP) and volume rendering (VR) images in work station.Results773 variations were totally detected among 500 patients. Variations were categorized as Willis polygon, fenestration and other variations. Frequent variations were detected at Willis polygon and posterior communicating artery (PCOA) hypoplasia was detected as the prevalent variation.ConclusionsIn the present study, we have demonstrated that cerebral vascular variations are frequent and that these variations can be detected in a non-invasive manner using the MDCT angiography. The results obtained from our study may serve as preoperative guidelines for the units performing surgical procedures.