Kamil Gurel

A comparative study of bimatoprost and travoprost: effect on intraocular pressure and ocular circulation in newly diagnosed glaucoma patients.

Background: This study compares intraocular pressure (IOP)-lowering efficacy and retrobulbar hemodynamic effects of bimatoprost and travoprost in patients with newly diagnosed open-angle glaucoma. Methods: Patients were randomly assigned to one of two treatment groups (bimatoprost group, n = 36; travoprost group, n = 46). IOP levels were measured with Goldmann applanation tonometer. Peak systolic velocity, end-diastolic velocity and resistivity index were obtained for each vessel by color Doppler imaging. Results: Both bimatoprost and travoprost significantly lowered IOP on days 30, 90 and 180 (p < 0.001). There was no significance between the 2 drugs on all follow-up visits. End-diastolic velocity of central retinal artery on day 180 was significantly higher than the value obtained at baseline in both groups. Conclusions: Patients were likely to achieve and maintain low target IOP with both drugs. Both drugs also resulted in improvement in the central retinal artery blood flow.

Ultrasound-guided puncture of the femoral artery for total percutaneous aortic aneurysm repair.

PURPOSE The purpose of this study was to evaluate the outcomes of ultrasound-guided femoral artery access for total percutaneous endovascular repair of abdominal and thoracic aortic aneurysms. MATERIALS AND METHODS Total percutaneous aneurysm repair of the abdominal and thoracic aorta was performed in 52 consecutive patients (46 males, 6 females; mean age, 64.6±16 years; age range, 24-93 years) in a total of 85 access arteries. Of the aortic aneurysms repaired, 33 were abdominal, and 19 were thoracic. Ultrasound- guided puncture of the access artery was performed in all patients. The access artery was closed with a Prostar XL device at the end of the procedure. RESULTS The outer diameter of the vascular sheaths or the stent graft system ranged from 14 F to 27 F. All but one patient achieved successful closure of the arterial puncture with the closure device. One patient required surgical cutdown because of device failure. Two patients required long-duration manual compression. Technical success was achieved in 49 patients (94%). Forty-five patients (87%) were discharged on the first postoperative day. There were no complications of the access arteries one day or one month postoperatively, as determined by ultrasonography and computed tomography examinations, respectively. The mean diameters of the access arteries prior to and one month after the procedure were unchanged, as demonstrated by computed tomography. CONCLUSION Ultrasound-guided puncture of the common femoral artery for percutaneous closure of the access site has a high technical success rate and a very low complication rate. The addition of ultrasound guidance decreases the difficulty of the procedure and helps to avoid some of its complications.

Lipoma Arborescens of the Suprapatellar Bursa and Extensor Digitorum Longus Tendon Sheath Report of 2 Cases

Lipoma arborescens (diffuse articular lipomatosis) is a rare intra‐articular lesion consisting of subsynovial villous proliferation of mature fat cells. The usual clinical presentation is painless swelling. The aim of this series was to emphasize the importance of gray scale and color Doppler sonography through the investigation of chronic joint swelling.

Paranasal computed tomography results in asthma patients: association between sinus sites and allergen types.

Chronic rhinosinusitis (CRS) is a common comorbidity of asthma. The aim of this study was to investigate the relationships between the presence of rhinosinusitis, sinus site involvement, and total computed tomography (CT) sinus scores and the presence of allergy, allergen type, and severity of disease. Asthma patients (128 subjects), consisting of 57 allergic and 71 nonallergic patients, were included in the study. Presence of rhinosinusitis and sinus scores were evaluated by CT. CRS was determined in 45 (78.9%) allergic asthma patients and 44 (62.0%) nonallergic asthma patients (p<0.05). Ethmoid sinus involvement was higher among allergic asthma patients compared with nonallergic patients (68.4% versus 43.7%; p=0.005). House-dust mite allergy (71.4% versus 46.5%; p=0.008) and pollen allergy (73.5% versus 47.9%; p=0.01) showed positive correlations with ethmoid sinus involvement. No correlation was found between severity of disease and mean total CT sinus scores (p>0.05). The present study has shown the prevalence of chronic sinusitis to be higher in patients with allergic asthma, particularly in patients allergic to house-dust mites and pollens, with no correlation between severity of disease and presence of CRS. Investigating chronic sinusitis together with allergen sensitivity early in asthma diagnosis may contribute positively to patient treatment.

Correlation between the renal resistive index (RI) and nonenhanced computed tomography in acute renal colic : How reliable is the RI in distinguishing obstruction?

Objective. The purpose of this study was to determine the sensitivity of renal color Doppler sonography in differentiating obstructive and nonobstructive urinary calculi in patients with acute renal colic and to compare findings with nonenhanced helical computed tomography (CT). Methods. Sixty‐five patients referred to the emergency department with acute renal colic underwent nonenhanced CT and renal resistive index (RI) measurement with color pulsed Doppler sonography within 8 to 10 hours of the onset of the symptoms. Computed tomographic evaluation was based on the detection of urolithiasis and classification according to location and the presence of obstruction. The mean RI of each kidney and the difference between the mean RI (ΔRI) of both kidneys were calculated and compared with CT findings. Results. A total of 164 stones were identified. Computed tomography revealed obstruction in 33 patients. Mean RI values for the obstructive and nonobstructive groups were 0.64 and 0.63, respectively. Mean ΔRI values were 0.01312 and 0.01000 in the obstructive and nonobstructive groups. The differences in the mean RI and ΔRI for the patients with and without obstruction were statistically insignificant (P = .73). No significant relationship was found between the RI values, calculus location, and degree of obstruction. Conclusions. The RI is insensitive for detection of obstruction in patients with acute renal colic, and its value in routine practice seems quite controversial.

Patellar tendinopathy caused by a para-articular/extraskeletal osteochondroma in the lateral infrapatellar region of the knee: a case report

Patellar tendinopathy is characterized by activity-related anterior knee pain. It is most commonly related to sports activity, but has also been reported in the non-athletic population. Most injuries are caused by microtrauma, resulting in tendinitis or tendinosis. Extraskeletal paraarticular osteochondromas, which occur in the soft tissues near the joint, are rare. The infrapatellar fat pad and joint capsule are the most common sites of these tumors. Here, a case of patellar tendinitis caused by an extraskeletal paraarticular osteochondroma is reported. The symptoms included intensifying pain upon flexion and a palpable click that was located at the medial side of the mass. The patient was pain-free within 3 weeks after excision of the tumor and the clicking disappeared. To our best knowledge, no other case of patellar tendinitis caused by an extraskeletal paraarticular osteochondroma has been reported in the English literature.

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.

US-guided retrograde tibial artery puncture for recanalization of complex infrainguinal arterial occlusions

PURPOSE We aimed to describe the technical aspects and outcomes of the retrograde tibial approach and balloon predilation for recanalization of complex infrainguinal arterial occlusions and determine the efficacy of this approach in minimizing failure rates. MATERIALS AND METHODS Between September 2006 and April 2011, antegrade revascularization failed in 22 limbs with complex total occlusions within the infrainguinal arterial territory. For each of these antegrade failure cases in 22 patients, a retrograde tibial puncture had been attempted. Percutaneous recanalization and predilation were initially performed through tibial access, and final balloon dilatation or stent placement was performed from antegrade femoral access. The patients were followed up for functionality and wound healing. RESULTS Access from the tibial artery was successfully obtained for all patients (100%). Successful recanalization was obtained in 18 patients (82%). Retrograde access was performed from the anterior tibial/dorsalis pedis artery in 12 patients and posterior tibial artery in 10 patients. One major and one minor complications were documented. CONCLUSION Retrograde tibial recanalization technique in the infrainguinal complex arterial occlusion safely increases the success rates of percutaneous recanalization in the failed traditional approach and is a feasible endovascular option to avoid more invasive, time-consuming, and high-risk procedures.

The Effect of Risedronate on Posterior Lateral Spinal Fusion in a Rat Model

OBJECTIVE To evaluate the potential effects of risedronate (RIS) which shows a higher anti-resorptive effect among bisphosphonates, after a posterolateral lumbar intertransverse process spinal fusion using both autograft and allograft in a rat model. METHODS A totoal of 28 Sprague-Dawley rats were randomized into 2 study groups. A posterolateral lumbar intertransverse process spinal fusion was peformed using both autograft and allograft in a rat model. Group I (control) received 0.1 mL of steril saline (placebo) and Group II (treatment) received risedronate, equivalent to human dose (10 microg/kg/week) for 10-weeks period. RESULTS The fusion rates as determined by manual palpation were 69% in the group I and 46% in the group II (p = 0.251). According to radiographic score, the spinal segment was considered to be fused radiographically in 7 (53%) of the 13 controls and 9 (69%) of the 13 rats treated with RIS (p = 0.851). The mean histological scores were 5.69 +/- 0.13 and 3.84 +/- 0.43 for the control and treatment groups, respectively. There was a significant difference between the both groups (p = 0.001). The mean bone density of the fusion masses was 86.9 +/- 2.34 in the control group and 106.0 +/- 3.54 in the RIS treatment group. There was a statistical difference in mean bone densities of the fusion masses comparing the two groups (p = 0.001). CONCLUSION In this study, risedronate appears to delay bone fusion in a rat model. This occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuation of risedronate postoperatively during acute fusion period may be warranted.

Silicosis in Manufacture of Electric Cable: Report of Four Cases

Free silica (silicon dioxide) is naturally found in amorphous and crystalline forms in many rocks in the Earth . Inhaled silicon dioxide is usually crystalline and most often quartz which is the most important form. Silicosis is an irreversible disease 3) that results from workrelated exposures to dusts containing silica crystals, and is characterized by fibrotic tissue reaction caused by the presence of silica in the lungs . Crystalline silica exposure and silicosis have been associated with work in mining, quarrying, tunneling, sandblasting, masonry, foundry work, glass manufacture, ceramic and pottery production, cement and concrete production, and work with certain materials in dental laboratories. The diagnosis of silicosis is based on history of exposure to silica dust and multiple, bilateral pulmonary nodules and large opacities on chest radiography . Several studies have demonstrated that high resolution computed tomography (HRCT) is superior to conventional radiography for detection of silicotic lesions, confluence of nodules, and presence of emphysema . Most pneumoconiosis evolves slowly and changes in radiological findings take a long time, usually years, to occur. However, in rare instances, such as acute silicosis associated with exposure to a very large quantity of very fine silicaceous dust, radiological changes can show up within months . We present clinical and radiological findings of four cases working in the same department producing ‘silicone paste’ by mixing quartz dust (a synonym for silicon dioxide (SiO 2 ), sil ica or sil icon) with sil icone (polysiloxane ([R 2 SiO] n , a class-name for various synthetic plastic substances made of silicon, oxygen, carbon, germanium, and hydrogen), in an electric cable factory, for 5 to 8 yr. Up to now, this branch of industry has not been reported in the English literature as a cause of silicosis.