Mehmet Burak Çildağ

Esophageal perforation during cuffed tunneled catheter introduction: First case in literature

The percutaneous catheterization of central veins is increasingly used in nephrological practice as a temporary or permanent vascular access. Some mechanical complications may occur during insertion of catheter such as misplaced catheter. In this report, we present a case that was misplaced the catheter in esophagus and to analyze the reason of catheter malposition during percutaneous tunneled hemodialysis catheter insertion.

Comparison of clinical and laboratory findings in patients with systemic lupus erythematosus with regard to age at onset

Objective Systemic lupus erythematosus (SLE) rarely has a late onset. Late-onset SLE (LSLE) has a milder course and less organ involvement. The purpose of the present study was to compare the clinical and laboratory (lab) findings of SLE regarding age at onset. Materials and Methods Seventy-two patients with SLE were included in the study. The age at onset was considered adult-onset SLE (ASLE) if it was <50 years and LSLE if it was ≥50 years. Lab parameters and clinical findings were compared accordingly. Results Overall, 41 (56.9%) patients had ASLE, and 31 (43.05%) patients had LSLE based on the age at onset. The ratio of female-to-male patients was higher in ASLE, and no significant difference was found with regard to gender distribution (12.6:1 and 5.2:1 for ASLE and LSLE, respectively; p=0.239). While malar rash and fever were more common in ASLE, no difference was found regarding the other clinical findings. Only IgG anti-cardiolipin was more common in LSE between the lab parameters. Conclusion Although it is known that LSLE has a milder course and less organ involvement, there are differences in clinical and lab findings and organ involvement in various studies. The results of our study showed no significant difference in organ involvement between ASLE and LSLE.

A factor increasing venous contamination on bolus chase three-dimensional magnetic resonance imaging: Charcot neuroarthropathy

Background: The study aimed to evaluate the ratio of venous contamination in diabetic cases without foot lesion, with foot lesion and with Charcot neuroarthropathy (CN). Materials and Methods: Bolus-chase three-dimensional magnetic resonance (MR) of 396 extremities of patients with diabetes mellitus was analyzed, retrospectively. Extremities were divided into three groups as follows: diabetic patients without foot ulcer or Charcot arthropathy (Group A), patients with diabetic foot ulcers (Group B) and patients with CN accompanying diabetic foot ulcers (Group C). Furthermore, amount of venous contamination classified as no venous contamination, mild venous contamination, and severe venous contamination. The relationship between venous contamination and extremity groups was investigated. Results: Severe venous contamination was seen in Group A, Group B, and Group C, 5.6%, 15.2%, and 34.1%, respectively. Statistically significant difference was seen between groups with regard to venous contamination. Conclusion: Venous contamination following bolus chase MR was higher in patients with CN.

The role of tomosynthesis in intraoperative specimen evaluation

To investigate the contribution of breast tomosynthesis to intraoperative specimen evaluation in subjects with breast cancer. Approval was obtained from the hospital ethics committee. Specimen mammography, tomosynthesis, and, if available, ultrasonography images were retrospectively assessed for 208 women who had undergone conservative surgery at our hospital between January 2013 and April 2016 after being diagnosed with breast cancer. The success of mammography, tomosynthesis, and ultrasonography in lesion detection and characterization was evaluated. Of 208 lesions, 142 (68.3%) and 198 (95.2%) were detected by mammography and tomosynthesis, respectively. All lesions were detected in 150 subjects undergoing ultrasonography (124 dense breasts, 26 fatty breasts). In 84 women who had fatty breasts, all lesions were detected both by mammography and by tomosynthesis. In 124 women with dense breasts, lesions were detected by mammography in 59 (48%) and in 114 (92%) by tomosynthesis. The success of tomosynthesis in lesion detection was found to be markedly higher than mammography (P = .00). In conclusion, tomosynthesis contributed to mammography in specimen evaluation in a total of 101 subjects. The success of tomosynthesis in lesion detection and characterization during intraoperative specimen evaluation is higher than mammography. In daily practice, ultrasonography is performed for lesions which cannot be evaluated by specimen mammography due to dense parenchymal pattern. Tomosynthesis may reduce the need for and the time and workforce allocated to specimen ultrasonography in an important group of subjects.

Angiographic assessment of atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy

Background: The aim of this study was to investigate atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro‐arthropathy and compare them with patients with diabetic foot without charcot neuro‐arthropathy. Methods: This retrospective study consists of 78 patients with diabetic foot who had lower extremity angiography with antegrade approach. All patients were classified into two groups; neuro ischemic wounds with charcot neuro‐arthropathy (30/78) and without charcot neuro‐arthropathy (48/78).Atherosclerotic load at the side of diabetic foot was determined by using the Bollinger angiogram scoring method. Comparison of atherosclerotic load between the two groups was performed. Results: The mean of total and infrapopliteal level angiogram scoring of all patients was 33.3 (standard deviation, sd:±17.2) and 29.3 (sd:±15.6), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds with charcot neuro‐arthropathy group was 18.1 (sd:±11.6) and 15.7 (sd:±10.4), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds without charcot neuro‐arthropathy group was 42.8 (sd:±12.7) and 37.7 (sd:±12.0), respectively. There was a statistically significant difference between the two groups of mean total and infrapopliteal angiogram scoring (p < 0.01). Conclusion: This angiographic study confirms that the atherosclerotic load in patients with diabetic foot and chronic charcot neuro‐arthropathy is significantly less than in patients with neuroischemic diabetic foot wounds without chronic charcot neuro‐arthropathy.

Evaluation of Pediatric Undescended Testes with Elastosonography

Background: Undescended testes, which are defined as the failure of testes to descend to scrotum, are the most common developmental defect in male infants. Indirect evaluation of histologic damage can be performed with the help of palpation during operation. Hard texture of testes tissue is likely related with histological damage. Real-time elastography is an emerging technology of ultrasonic imaging of soft tissue strain and elasticity, it aims at providing information regarding the mechanical properties of tissues, such as their hardness or stiffness. This study aim was to investigate the changes in strain and elasticity of testes tissue by using elastography technique. Materials and methods: A total of 32 patients, who had undescended testes were included in this study. Only two patients had bilateral undescended testes, other patients had unilateral. The age of the patients were recorded according to the time of ultrasonographic (USG) examination. The undescended testes was displayed in the elastographic box with the neighbouring subcutaneous fat tissues. The strain ratios were measured as the ratios of the elasticities of the subcutaneous fat tissue to the elasticities of the undescended testes. Results: A total of 32 patients with 34 testes were included in the study. The mean age of the patients with undescended testes was 32.6 months (range 7–60 months). The mean strain ratios were 0.67 (range 0.12–1.41) for the undescended testes and there were no significant differences in undescended testes strain ratios related to patient age (p = 0.453). Conclusion: This preliminary study showed that there were no significant fibrosis which can be demonstrated with elastosonography before the age of 5 years old. Additional studies with his-topathological results are needed to identify sensitivity and specificity of elastosonography in undescended testis and in planning optimal operation time for these patients.

The Effect of Charcot Neuroarthropathy on Limb Preservation in Diabetic Patients with Foot Wound and Critical Limb Ischemia after Balloon Angioplasty

Objective The aim of this article is to investigate one-year limb preservation rates after below-the-knee angioplasty in patients with diabetic foot wound who only have critical limb ischemia (CLI) and those who have Charchot neuroarthropathy (CN) accompanied by CLI. Methods This single-center, retrospective study consists of 63 patients with diabetic foot wound who had undergone lower extremity balloon angioplasty of at least 1 below-the-knee (BTK) vessel. Only those patients with postprocedural technical success of 100% were selected from the database. All patients were classified into two groups as patients with CLI and CN and patients with CLI only without CN. The Kaplan-Meier method was used to compare the limb preservation rates for the two groups. Results There was no statistically significant difference between patient age, gender, diabetic disease duration, and comorbid disease such as chronic renal insufficiency, hypertension, and coronary artery disease of the two groups (p > 0.05). Limb preservation in the 12 months was 59.1% in the CN group and 92.7% in the group without CN. Also, limb preservation rates between the two groups displayed statistically significant differences (p < 0.005). Conclusion This study showed that CLI can accompany CN in patients with diabetes. Limb preservation rates with endovascular treatment in diabetic patients with CLI only are better than in diabetic patients with CLI and CN.

Esophageal perforation during cuffed tunneled catheter introduction: First case in literature: Esophagus perforation due to catheter

The percutaneous catheterization of central veins is increasingly used in nephrological practice as a temporary or permanent vascular access. Some mechanical complications may occur during insertion of catheter such as misplaced catheter. In this report, we present a case that was misplaced the catheter in esophagus and to analyze the reason of catheter malposition during percutaneous tunneled hemodialysis catheter insertion.