Mehmet Emin Sakarya

Abdominal hydatid disease: Long-term results of percutaneous treatment

Purpose: To evaluate the effectiveness of percutaneous treatment under sonographic guidance in abdominal hydatid cysts. Material and Methods: Fifty‐two hydatid cysts in 33 patients were treated using a percutaneous approach under sonographic guidance. Forty‐five cysts were located in the liver, 6 in the spleen, and 1 in the pancreas. Forty‐nine cysts were type I, and 3 were type II. Thirty‐one cysts in 15 patients were treated with puncture and aspiration of the contents, injection of hypertonic saline solution, and respiration (PAIR); 15 cysts in 14 patients were treated with puncture, aspiration of cyst contents, injection of hypertonic saline solution, drainage, and injection of sclerosing agent (PAIDS); and 6 cysts in 4 patients were treated with puncture, aspiration of cyst contents, injection of sclerosing agent, and re‐aspiration (mPAIDS). Hypertonic saline or alcohol was used as a scolicidal agent. The follow‐up period was between 17 and 53 months. Results: A decrease in the dimensions of the cysts, solidification of the contents, and irregularity in the walls of cysts, all of which were considered signs of cure, were found in all patients. Recurrence was observed in one case and anaphylaxis in one. Conclusion: Percutaneous treatment of abdominal hydatid cysts is a safe, easily applicable, well‐tolerated, and effective method.

Transesophageal echocardiographic detection of a pulmonary artery aneurysm complicated by thrombus

The incidence of aneurysms of the pulmonary artery is known to be very low. Although diagnosis and evaluation of pulmonary artery aneurysms may be difficult without angiography, computed tomography and MRIs have emerged as useful noninvasive techniques. However, a transthoracic echocardiogram may reveal a pulmonary artery aneurysm. To our knowledge, transesophageal echocardiographic findings of pulmonary artery aneurysm with thrombus have not been reported in detail. Here, a case of thrombosed aneurysm of the main pulmonary artery diagnosed by transesophageal echocardiography and confirmed by computed tomography and MRI is reported.

Detection and quantification of the parenchymal abnormalities in emphysema using pulmo-CT.

We aimed to determine the degree and extent of parenchymal abnormalities on pulmo-CT in patients with emphysema. The study group consisted of 29 patients (18 male, 11 female; mean age 57.9+/-13). The diagnosis was based on clinical symptoms, pulmonary function tests (PFT) values, and chest CT findings. All of the patients CT scans were obtained during suspended deep inspiration from the apices to the costophrenic angles. The mean lung attenuation (MLD) and parenchymal abnormalities related to emphysema were quantitatively calculated with tables, histograms and graphics at the whole lung. The lung density measurements revealed a mean density of -898.48+/-51.37 HU in patients with emphysema and -825.1+/-25.5 HU in control group. In addition, mean percentage of subthreshold attenuation values was found as 12.03+/-15.75 and 1.07+/-0.83 in patients with emphysema and control group, respectively. Compared with control group, the patients with emphysema had a significantly lower inspiratory MLD (p<0.05). Additionally, statistically significant correlations were seen between the MLD and percentage of subthreshold values (r=0.44, p<0.05). In contrast, there was poor correlation between PFT measurements and the subthreshold values. In conclusion, pulmo-CT is a quick, simple method for quantitative confirmation of the presence of parenchymal abnormalities of lung as mosaic attenuation and should be used in combination with other radiological methods and PFT as it gives additional information to routine examinations in patients with emphysema.

The evaluation of morphometry of the mastoid process using multidetector computed tomography in a living population.

AbstractThe aim of this study was to examine the relationships of the bony landmarks on the lateral surface of the mastoid process (MP). It was also the target of this study to reveal the importance of sexual dimorphism in terms of the mastoid triangle. Our study was performed on 140 (70 women, 70 men) multidetector computed tomography images obtained from patients who underwent radiologic examination at the Department of Radiology of Meram Medical Faculty, Necmettin Erbakan University. The height of the MP was measured using 2 different ways. The distance between the mastoid apex and the midpoint of the distance of the porion and the mastoid notch was measured (mastoid height 1). Then, the distance between the Frankfurt horizontal plane and the mastoid apex was measured (mastoid height 2). The distances between porion–mastoid notch, porion–mastoid apex, porion-asterion, asterion–mastoid apex, articular tubercle–asterion, articular tubercle–mastoid apex, as well as the right and the left MP were also measured. Finally, the angles between porion–mastoid apex–asterion, mastoid apex–asterion– porion, and asterion–porion–mastoid apex were measured. All data were analyzed statistically using the Student’s t-test. According to the results of the measurements, all right and left parameters of the men were higher than the women’s right and left sides except for the angle between asterion–porion–mastoid apex. In addition, all right and left parameters were almost the same in both sexes. Having the knowledge of measurements of the distances between the major landmarks of the temporal bone is essential to avoid possible complications during facial, mastoid, and especially sigmoid sinus surgeries.

Morphometric Analysis of Styloid Process Using Multidetector Computed Tomography.

AbstractStyloid process (SP) is a cylindrical anatomical structure located at the anterior side of stylomastoid foramen. Normally, it is 20 to 25 mm in length and can vary with ageand sex. An elongated SP is an unusual source of craniofacial and cervical pain. In this study, the clinical role of morphometric data of SP was discussed.In this study, 64-slice multidetector computed tomography images (Somatom Sensation 64, Siemens, Germany) from Radiology Departments archive of Necmettin Erbakan University were used. The examined images were collected from 100 patients (31 female and 69 male). Length of SP (SPL), SP width (SPW), distance between SP rooths (DBR), SPs angulation, and the distance between SP and internal carotid artery (SP-ICA) were measured.Statistical differences were found regarding to the data of SPL, SPW, DBR, and SP-ICA left between sexes. No statistical significance was detected between right and left side SPL (paired t test; P = 0.989, P > 0.05). SP was observed as mostly type A1 (right %55, left %52). These parameters were also compared with those of previous studies.The present study showed side and sex differences and types of SP. We believe that it was necessary to determine the normal range of values for different populations, and this knowledge will provide guidance to surgeons in the examination of this area.

Comparison of ventilation-perfusion scintigraphy with MR angiography in patients with Swyer-James syndrome.

Purpose The aim of this study was to establish the value of magnetic resonance angiography (MRA) in diagnosing) Swyer-James syndrome (SJS) and to compare MRA and ventilation-perfusion (V/Q) scan results in patients with established SJS. Methods The V/Q scans and the MRA findings of 22 lungs of 11 patients with SJS (6 males, 5 females; age range: 17–69 years, mean: 38.4 years) were retrospectively studied. The perfusion scan was performed after the injection of 99mTc macroaggregated albumin. After 2 days, the ventilation scan was performed by using 99mTc diethylene triamine penta-acetic acid aerosol. The MRA was performed with a 1.5 T magnetic resonance unit. We compared the MRA and V/Q scan findings of the lungs of the patients. Results The V/Q scans showed the characteristic pattern of a matched V/Q defect on the affected lungs. The MRA displayed a smaller pulmonary artery and markedly poor peripheral vasculature on the affected side in all patients. The MRA had a sensitivity of 84.6%, a specificity of 100% for the detection SJS. Interobserver variability was minimum as indicated by a weighted kappa statistic of 0.818. Conclusion This study indicates that the MRA is a fast, accurate, without radiation, and noninvasive technique for supporting the diagnosis of SJS. But, V/Q scans showed additional segmental perfusion/ventilation abnormalities on contralateral lung to reveal the segmental involvement of SJS. As a result, the MRA has no more any extra advantages for patient management.

Pulsatility Index of Popliteal Artery in Patients with Isolated Calf Vein Thrombosis: A Novel Technique for Detecting Thrombosis

Summary Background To investigate the usefulness of popliteal artery spectral doppler findings as a complimentary approach to isolated calf vein thrombosis (DVT). Material/Methods We included consecutive patients presenting with symptomatic and sonographically proven acute isolated calf DVT. Patients with thrombosis of any other vein were excluded. We classified calf vein into into four main types. We investigated how many of these four vessels had DVT and compared them with respect to the pulsatility index (PI) value of the popliteal artery. Results We evaluated spectral doppler characteristics of the popliteal artery on the same side as the isolated calf vein thrombosis as well as on the opposite side. The relationship between PI values of the popliteal artery and the number of thrombosed calf veins was investigated. In patients with 1 and/or 2 thrombosed veins, the mean PI was 6.03±0.54 on the side of cDVT and 5.68±0.39 on the opposite side (p=0.008), respectively. Inpatients with 3 and/or 4 thrombosed veins, the mean PI was 8.05±0.61 on the side of cDVT and 6.34±0.47 on the opposite side (p=0.001), respectively. Conclusions Venous doppler sonography for the evaluation of calf DVT may be limited by patient characteristics such as obesity, edema, and tenderness., Arterial PI can be used as a complimentary technique for the detection of venous thrombosis in such of cases.

Late Systolic Wave on Brachial Artery Blood Flow Velocity Pattern in Patients with Coronary Artery Disease and its Relation to Vascular Stiffness

Duplex-Doppler study typically exhibits triphasic brachial artery blood flow velocity pattern in subjects classified as normal without clinically evident atherosclerotic complications, heart disease, hypertension, or diabetes mellitus. In this study, the authors described the late systolic wave on the brachial artery blood flow velocity pattern in patients with coronary artery disease and investigated the relation between late systolic wave and vascular stiffness. Blood flow profile and velocity of the brachial artery were determined noninvasively by ultrasound pulsed-Doppler technique under the guidance of a B-mode ultrasound image in 96 patients with coronary artery disease (CAD). The control group consisted of 23 healthy subjects with no or maximally 2 risk factors (only among age, cigarette smoking, obesity, and gender) for vascular disease. None of the patients and controls had clinical evidence of arterial disorders at upper extremities. In 32 patients (33%) with CAD, a late systolic wave was observed in the brachial artery Doppler study. On the other hand, no late systolic wave was observed in the healthy subjects. In addition, multivessel disease, hypertension, advanced age, diabetes, and smoking were significantly more frequent in patients with the late systolic wave. In conclusion, peripheral arterial abnormalities induced by vascular stiffness may produce alterations in regional wave reflections, and the normal triphasic pattern of the brachial artery blood flow may change by the appearance of the late systolic wave.

The club-shaped cord terminus in siblings with caudal agenesis: MRI

Abstract We report a rare instance of caudal agenesis occurring in siblings, with MRI. Both our patients had a club-shaped spinal cord, ending at T11. Radiological and urological findings are presented.